Provider Demographics
NPI:1497865133
Name:SILVER, JERILYN H (MA MSW)
Entity Type:Individual
Prefix:MRS
First Name:JERILYN
Middle Name:H
Last Name:SILVER
Suffix:
Gender:F
Credentials:MA MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 OFFICE COURT DRIVE
Mailing Address - Street 2:SUITE 604
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507
Mailing Address - Country:US
Mailing Address - Phone:505-984-2241
Mailing Address - Fax:505-455-2058
Practice Address - Street 1:600 EAST FAIRVIEW LANE
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532
Practice Address - Country:US
Practice Address - Phone:505-984-2241
Practice Address - Fax:505-455-2058
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNMI0953103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist