Individual provider Active NPI

Todd Russell Silverstein, PSY.D.

  • Clinical Neuropsychologist
  • Loma Linda, CA
National Provider Identifier
1366493462
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
6301014521 Issued in MI
Practice address
11201 Benton St
Loma Linda, CA 92357-4722
Phone
(909) 825-7084
NPI assigned
May 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Psychologist 103TA0400X 6301014521 MI
Adult Development & Aging Psychologist 103TA0700X 6301014521 MI
Cognitive & Behavioral Psychologist 103TB0200X 6301014521 MI
Clinical Psychologist 103TC0700X 6301014521 MI
Clinical Child & Adolescent Psychologist 103TC2200X 6301014521 MI
Family Psychologist 103TF0000X 6301014521 MI
Forensic Psychologist 103TF0200X 6301014521 MI
Health Psychologist 103TH0004X 6301014521 MI
Intellectual & Developmental Disabilities Psychologist 103TM1800X 6301014521 MI
Group Psychotherapy Psychologist 103TP2701X 6301014521 MI
Clinical Neuropsychologist 103G00000X 6301014521 MI Primary
Psychologist 103T00000X 6301014521 MI

Addresses

Primary practice location

11201 Benton St
Loma Linda, CA 92357-4722

Mailing address

PO Box 331
Norway, MI 49870-0331
Phone (906) 309-2061

Other practice location 1

1112 Carpenter Ave
Iron Mountain, MI 49801-4722
Phone (906) 828-4283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6301014521MIMDCognitive & Behavioral Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1366493462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 331",
            "city": "NORWAY",
            "state": "MI",
            "postal_code": "498700331",
            "telephone_number": "906-309-2061",
            "fax_number": "888-874-5476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 BENTON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923574722",
            "telephone_number": "909-825-7084"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1112 Carpenter Ave",
            "address_purpose": "LOCATION",
            "city": "Iron Mountain",
            "state": "MI",
            "postal_code": "498014722",
            "country_code": "US",
            "telephone_number": "906-828-4283",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SILVERSTEIN",
        "first_name": "TODD",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TF0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Forensic",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TH0004X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301014521",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301014521",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.