Provider Demographics
NPI: | 1366493462 |
---|---|
Name: | SILVERSTEIN, TODD RUSSELL (PSYD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | TODD |
Middle Name: | RUSSELL |
Last Name: | SILVERSTEIN |
Suffix: | |
Gender: | M |
Credentials: | PSYD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 608 STEPHENSON ST |
Mailing Address - Street 2: | |
Mailing Address - City: | NORWAY |
Mailing Address - State: | MI |
Mailing Address - Zip Code: | 49870-1152 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 906-309-2061 |
Mailing Address - Fax: | 888-874-5476 |
Practice Address - Street 1: | 1112 CARPENTER AVE |
Practice Address - Street 2: | |
Practice Address - City: | IRON MOUNTAIN |
Practice Address - State: | MI |
Practice Address - Zip Code: | 49801-4722 |
Practice Address - Country: | US |
Practice Address - Phone: | 906-828-4283 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-05-13 |
Last Update Date: | 2023-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MI | 6301014521 | 103G00000X, 103T00000X, 103TA0400X, 103TA0700X, 103TB0200X, 103TF0000X, 103TF0200X, 103TM1800X, 103TP2701X, 103TC0700X |
103TC2200X, 103TH0004X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | |
No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | |
No | 103TA0400X | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |