Provider Demographics
NPI:1750560256
Name:SILVA, AGNES BRZESKA (MFT)
Entity type:Individual
Prefix:MRS
First Name:AGNES
Middle Name:BRZESKA
Last Name:SILVA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:AGNIESZKA
Other - Middle Name:BRZEKSA
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:719 2ND ST
Mailing Address - Street 2:STE. 3
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4656
Mailing Address - Country:US
Mailing Address - Phone:530-753-2032
Mailing Address - Fax:530-753-2032
Practice Address - Street 1:719 2ND ST
Practice Address - Street 2:STE. 3
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4656
Practice Address - Country:US
Practice Address - Phone:530-753-2032
Practice Address - Fax:530-753-2032
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist