Healthcare Provider Details

I. General information

NPI: 1447027909
Provider Name (Legal Business Name): GENEVIEVE JENNA S VIVALDI AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 ORANGE AVE
FAIR OAKS CA
95628-5810
US

IV. Provider business mailing address

PO BOX 806
FAIR OAKS CA
95628-0806
US

V. Phone/Fax

Practice location:
  • Phone: 916-520-9047
  • Fax:
Mailing address:
  • Phone: 916-520-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT143248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: