Provider Demographics
NPI:1447027909
Name:VIVALDI, GENEVIEVE JENNA S (AMFT)
Entity type:Individual
Prefix:
First Name:GENEVIEVE JENNA
Middle Name:S
Last Name:VIVALDI
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 806
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-0806
Mailing Address - Country:US
Mailing Address - Phone:916-520-9047
Mailing Address - Fax:
Practice Address - Street 1:4155 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3614
Practice Address - Country:US
Practice Address - Phone:415-480-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT143248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist