Provider Demographics
NPI:1023663465
Name:SILTON-GOLDSTEIN, MYRNA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MYRNA
Middle Name:ANN
Last Name:SILTON-GOLDSTEIN
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 1:530 WILSHIRE BLVD STE 306
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1426
Mailing Address - Country:US
Mailing Address - Phone:310-395-4961
Mailing Address - Fax:310-260-1181
Practice Address - Street 1:530 WILSHIRE BLVD STE 306
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1426
Practice Address - Country:US
Practice Address - Phone:310-395-4961
Practice Address - Fax:310-260-1181
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10725103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty