Provider Demographics
NPI:1689864076
Name:SILVA, RANDY GEORGE (PHD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:GEORGE
Last Name:SILVA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:GEORGE
Other - Middle Name:RANDELL
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PDD
Mailing Address - Street 1:1240 GENEVA AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3841
Mailing Address - Country:US
Mailing Address - Phone:415-290-6652
Mailing Address - Fax:
Practice Address - Street 1:2970 HILLTOP MALL RD STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-1948
Practice Address - Country:US
Practice Address - Phone:510-323-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health