Provider Demographics
NPI:1346381571
Name:DE SILVA, RAUDERICK S (MFT)
Entity Type:Individual
Prefix:MR
First Name:RAUDERICK
Middle Name:S
Last Name:DE SILVA
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-1235
Mailing Address - Country:US
Mailing Address - Phone:415-836-1700
Mailing Address - Fax:415-836-1737
Practice Address - Street 1:760 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-1235
Practice Address - Country:US
Practice Address - Phone:415-836-1700
Practice Address - Fax:415-836-1737
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 45375106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist