Basic Information
| Provider Information | |||||||||
| NPI: | 1942392279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILVER | ||||||||
| FirstName: | ELLEN | ||||||||
| MiddleName: | J | ||||||||
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| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 RAVENSBROOK CT | ||||||||
| Address2: | |||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140681340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166899545 | ||||||||
| FaxNumber: | 7166774240 | ||||||||
| Practice Location | |||||||||
| Address1: | 3802 SENECA ST | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142243433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166775418 | ||||||||
| FaxNumber: | 7166774240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | R033763-1 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 00020510001 | 01 | NY | UNIVERA HEALTHCARE | OTHER | 000528358005 | 01 | NY | BC/BS OF WNY | OTHER | 6290103 | 01 | NY | IHA | OTHER |