Provider Demographics
NPI:1780344499
Name:SILVA, LORENA DIAS ROCO
Entity type:Individual
Prefix:
First Name:LORENA
Middle Name:DIAS ROCO
Last Name:SILVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:DIAS
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4850 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-9773
Mailing Address - Country:US
Mailing Address - Phone:650-995-0520
Mailing Address - Fax:
Practice Address - Street 1:4850 GEORGE RD
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-9773
Practice Address - Country:US
Practice Address - Phone:650-995-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAJJ84601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program