Provider Demographics
NPI:1023059789
Name:SILVERSTONE, MARC J (PHD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:J
Last Name:SILVERSTONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4750 HARDWOODS DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2636
Mailing Address - Country:US
Mailing Address - Phone:734-728-2130
Mailing Address - Fax:734-728-2626
Practice Address - Street 1:6149 N WAYNE RD
Practice Address - Street 2:
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48185-7128
Practice Address - Country:US
Practice Address - Phone:734-728-2130
Practice Address - Fax:734-728-2626
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIMS063878103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI204553558OtherTAX ID
MIS10678Medicare UPIN