Provider Demographics
NPI:1821178146
Name:SILVERMAN, PENNY (LCSW)
Entity Type:Individual
Prefix:
First Name:PENNY
Middle Name:
Last Name:SILVERMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PENNY
Other - Middle Name:
Other - Last Name:SILVERMAN-MINGOLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:46 LAKECLIFF DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-446-5730
Mailing Address - Fax:386-671-7503
Practice Address - Street 1:1 FLORIDA PARK DRIVE SOUTH
Practice Address - Street 2:STE 315
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-446-5730
Practice Address - Fax:386-671-7503
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLSW26151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
71174OtherCIGNA
Z3979Medicare ID - Type Unspecified