Provider Demographics
NPI:1104143353
Name:SILVERSTEIN, JAY MICHAEL (PHD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:MICHAEL
Last Name:SILVERSTEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W PARK AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3301
Mailing Address - Country:US
Mailing Address - Phone:516-507-4678
Mailing Address - Fax:516-889-9135
Practice Address - Street 1:120 W PARK AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3301
Practice Address - Country:US
Practice Address - Phone:516-507-4678
Practice Address - Fax:516-889-9135
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011020-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical