Provider Demographics
NPI:1851587992
Name:SILVERSTEIN, CHARLES I (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:I
Last Name:SILVERSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 804
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-0804
Mailing Address - Country:US
Mailing Address - Phone:415-884-0229
Mailing Address - Fax:
Practice Address - Street 1:1088 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4963
Practice Address - Country:US
Practice Address - Phone:415-884-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-22
Last Update Date:2007-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6777103T00000X
HI994103TB0200X
103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic