Provider Demographics
NPI:1992747398
Name:SILBERT, IAN SHELLY (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:SHELLY
Last Name:SILBERT
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9119 BOCA GARDENS CIR S
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33496-3709
Mailing Address - Country:US
Mailing Address - Phone:305-725-3125
Mailing Address - Fax:561-296-5287
Practice Address - Street 1:11120 S CROWN WAY STE 1
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8718
Practice Address - Country:US
Practice Address - Phone:305-725-3125
Practice Address - Fax:561-793-0669
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW31151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ5197Medicare ID - Type Unspecified