Provider Demographics
NPI:1790412369
Name:GALVAN, BENERALDA MARIA
Entity Type:Individual
Prefix:
First Name:BENERALDA
Middle Name:MARIA
Last Name:GALVAN
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 1:23400 HILLMAN CT
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-9008
Mailing Address - Country:US
Mailing Address - Phone:530-209-7329
Mailing Address - Fax:
Practice Address - Street 1:1304 EAST ST STE 203
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0855
Practice Address - Country:US
Practice Address - Phone:916-581-0340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA133721106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist