Provider Demographics
NPI:1508421231
Name:SILBERMAN, MALLORY (LCSW)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:SILBERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 GREY WOLF DR
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2879
Mailing Address - Country:US
Mailing Address - Phone:847-220-3382
Mailing Address - Fax:
Practice Address - Street 1:29 GREY WOLF DR
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2879
Practice Address - Country:US
Practice Address - Phone:847-220-3382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.103467104100000X
IL149.0244041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149.024404OtherLICENSE NUMBER