Provider Demographics
NPI:1851453526
Name:SILVA, SANDRA (MFT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 ROSEBERRY CT
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-4105
Mailing Address - Country:US
Mailing Address - Phone:707-693-6614
Mailing Address - Fax:
Practice Address - Street 1:1745 ENTERPRISE DR BLDG 2 # MS 2-270
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5801
Practice Address - Country:US
Practice Address - Phone:707-399-4946
Practice Address - Fax:707-399-4957
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41656106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist