Provider Demographics
NPI:1821502899
Name:VATINELLE, SYLVIE MARIE (12017-R)
Entity Type:Individual
Prefix:
First Name:SYLVIE
Middle Name:MARIE
Last Name:VATINELLE
Suffix:
Gender:F
Credentials:12017-R
Other - Prefix:MRS
Other - First Name:SYLVIE
Other - Middle Name:
Other - Last Name:VATINELLE DE LA CRUZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:540 MIDDLE RINCON RD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409
Mailing Address - Country:US
Mailing Address - Phone:707-335-0702
Mailing Address - Fax:707-571-5531
Practice Address - Street 1:540 MIDDLE RINCON RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409
Practice Address - Country:US
Practice Address - Phone:707-335-0702
Practice Address - Fax:707-571-5531
Is Sole Proprietor?:No
Enumeration Date:2017-11-28
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12017-R101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
12017-ROtherCALIFORNIA ASSOCIATION FOR ALCOHOL AND DRUG EDUCATORS