Healthcare Provider Details

I. General information

NPI: 1770224776
Provider Name (Legal Business Name): BRENDA YESENIA MORGAN-RIVERA I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 STONY CIR STE 1200
SANTA ROSA CA
95401-4174
US

IV. Provider business mailing address

131 STONY CIR STE 1200
SANTA ROSA CA
95401-4174
US

V. Phone/Fax

Practice location:
  • Phone: 707-509-9373
  • Fax:
Mailing address:
  • Phone: 707-509-9373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10630
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number128325
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: