Provider Demographics
NPI:1063580132
Name:SILVER, JACK BARNARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:JACK
Middle Name:BARNARD
Last Name:SILVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 E CANDLESTICK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2104
Mailing Address - Country:US
Mailing Address - Phone:602-751-9044
Mailing Address - Fax:866-425-8068
Practice Address - Street 1:2017 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2102
Practice Address - Country:US
Practice Address - Phone:602-452-4684
Practice Address - Fax:602-358-0399
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW10958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW10958OtherTHERAPIST