Provider Demographics
NPI:1194050310
Name:SILVER, REVITAL ROTEM (LMHC)
Entity type:Individual
Prefix:MRS
First Name:REVITAL
Middle Name:ROTEM
Last Name:SILVER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RINDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3019
Mailing Address - Country:US
Mailing Address - Phone:781-862-8605
Mailing Address - Fax:
Practice Address - Street 1:35 RINDGE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3019
Practice Address - Country:US
Practice Address - Phone:781-862-8605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3780101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health