Provider Demographics
NPI:1073748836
Name:SILVERMAN FOOTE, AUDREY (MFT)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:SILVERMAN FOOTE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 MAUREEN LN
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2758
Mailing Address - Country:US
Mailing Address - Phone:925-685-5585
Mailing Address - Fax:
Practice Address - Street 1:569 MAUREEN LN
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2758
Practice Address - Country:US
Practice Address - Phone:925-685-5585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAMFC21077106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist