Provider Demographics
NPI:1104155118
Name:SILLING, STEPHEN MARC (PHD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARC
Last Name:SILLING
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 1:267 W GARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1329
Mailing Address - Country:US
Mailing Address - Phone:330-620-0405
Mailing Address - Fax:330-972-5679
Practice Address - Street 1:267 W GARWOOD DR
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1329
Practice Address - Country:US
Practice Address - Phone:330-620-0405
Practice Address - Fax:330-972-5679
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3261103TA0400X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)