Provider Demographics
NPI:1578578142
Name:WEINICK SILBERT, ELLEN D (LICSW)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:D
Last Name:WEINICK SILBERT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 SEAWARD BND
Mailing Address - Street 2:
Mailing Address - City:TEATICKET
Mailing Address - State:MA
Mailing Address - Zip Code:02536-5843
Mailing Address - Country:US
Mailing Address - Phone:860-575-4062
Mailing Address - Fax:
Practice Address - Street 1:275 SEAWARD BND
Practice Address - Street 2:
Practice Address - City:TEATICKET
Practice Address - State:MA
Practice Address - Zip Code:02536-5843
Practice Address - Country:US
Practice Address - Phone:860-575-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1178061041C0700X
CT0010431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT336214OtherMHN
CT140001043CT03OtherANTHEM BLUE CROSS