Provider Demographics
NPI:1700142643
Name:SILVEIRA, LUIZA GONCALVES (MSW)
Entity type:Individual
Prefix:
First Name:LUIZA
Middle Name:GONCALVES
Last Name:SILVEIRA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:LUIZA
Other - Middle Name:MANNO
Other - Last Name:GONCALVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:588 BLOSSOM HILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-3211
Mailing Address - Country:US
Mailing Address - Phone:408-607-7240
Mailing Address - Fax:
Practice Address - Street 1:588 BLOSSOM HILL RD STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3211
Practice Address - Country:US
Practice Address - Phone:408-607-7240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31644101YM0800X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health