Healthcare Provider Details

I. General information

NPI: 1235884313
Provider Name (Legal Business Name): MR. KENT JOHN SIVORI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 AUBURN BLVD STE A
SACRAMENTO CA
95821-2132
US

IV. Provider business mailing address

9312 LANCASHIRE CT
ELK GROVE CA
95758-4762
US

V. Phone/Fax

Practice location:
  • Phone: 916-300-6576
  • Fax:
Mailing address:
  • Phone: 916-709-7840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT157223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: