Healthcare Provider Details

I. General information

NPI: 1790617652
Provider Name (Legal Business Name): JENNA VIVALDI THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
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: 916-856-7372
  • Fax:
Mailing address:
  • Phone: 916-856-7372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GENEVIEVE JENNA VIVALDI
Title or Position: PRESIDENT
Credential: LMFT
Phone: 916-856-7372