Provider Demographics
NPI:1871512194
Name:SILK, JACQUELINE ELYDA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ELYDA
Last Name:SILK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 E DEL MAR BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-4322
Mailing Address - Country:US
Mailing Address - Phone:626-744-2940
Mailing Address - Fax:626-844-0023
Practice Address - Street 1:2810 E DEL MAR BLVD STE 2
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-4322
Practice Address - Country:US
Practice Address - Phone:626-744-2940
Practice Address - Fax:626-844-0023
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical