Provider Demographics
NPI:1528584661
Name:SILVERMAN, JACLYN ELISE
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ELISE
Last Name:SILVERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-4106
Mailing Address - Country:US
Mailing Address - Phone:818-263-6883
Mailing Address - Fax:805-965-3797
Practice Address - Street 1:107 E MICHELTORENA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-1905
Practice Address - Country:US
Practice Address - Phone:805-965-6786
Practice Address - Fax:805-965-3797
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health