Provider Demographics
NPI:1619178175
Name:SILVERBERG, LESLEY ANNE (LISW)
Entity type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:ANNE
Last Name:SILVERBERG
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2867 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3711
Mailing Address - Country:US
Mailing Address - Phone:330-928-7773
Mailing Address - Fax:
Practice Address - Street 1:2867 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:OH
Practice Address - Zip Code:44224-3711
Practice Address - Country:US
Practice Address - Phone:330-928-7773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI - 00041691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY057077OtherVALUE OPTIONS
R72940Medicare UPIN
OHSISW03382Medicare ID - Type Unspecified