Provider Demographics
NPI:1730443359
Name:MACHADO, SILVIO (PSYCHOLOGIST)
Entity type:Individual
Prefix:DR
First Name:SILVIO
Middle Name:
Last Name:MACHADO
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94953-0325
Mailing Address - Country:US
Mailing Address - Phone:707-529-3021
Mailing Address - Fax:
Practice Address - Street 1:115 LIBERTY ST
Practice Address - Street 2:STE 10
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2320
Practice Address - Country:US
Practice Address - Phone:707-529-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25053103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1598786352Medicaid
CA051100Medicare Oscar/Certification