MEDICARE: GENEVIEVE JENNA S VIVALDI AMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	AMFT143248	CA

General Provider Information

NPI Number	:	1447027909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVIEVE JENNA S VIVALDI AMFT

Provider Business Mailing Address
First Line	:	PO BOX 806
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-0806
Country	:	US
Telephone Number	:	916-520-9047
Fax Number	:

Provider Business Practice Location Address
First Line	:	7825 ORANGE AVE
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-5810
Country	:	US
Telephone Number	:	916-520-9047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	06/02/2026

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