Provider Demographics
NPI:1396088753
Name:SILVA, JOANNE GRACE (MFT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:GRACE
Last Name:SILVA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:GRACE
Other - Last Name:SILVA-WENDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:3775 BRICKWAY BLVD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-9051
Mailing Address - Country:US
Mailing Address - Phone:707-338-0223
Mailing Address - Fax:707-575-7085
Practice Address - Street 1:3775 BRICKWAY BLVD
Practice Address - Street 2:SUITE 130
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-9051
Practice Address - Country:US
Practice Address - Phone:707-338-0223
Practice Address - Fax:707-575-7085
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist