Provider Demographics
NPI:1770031775
Name:SILVA, BRENDA JACQUELYN
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:JACQUELYN
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3618 STEMMLER DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1069
Mailing Address - Country:US
Mailing Address - Phone:916-928-0884
Mailing Address - Fax:916-928-0884
Practice Address - Street 1:1241 ALAMO DR
Practice Address - Street 2:SUITE 3
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5620
Practice Address - Country:US
Practice Address - Phone:707-330-7904
Practice Address - Fax:707-330-7904
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF94815106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist