Active NPI
Jill Ann Silverman, M.F.T.
- Marriage & Family Therapist
- Petaluma, CA
National Provider Identifier
1124315148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC31242
- Practice address
- 204 G St
Suite 204
Petaluma, CA 94952-4262 - Phone
- (707) 782-1222
- NPI assigned
- Jun 29, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC31242 | CA | Primary |
Addresses
Primary practice location
204 G St
Suite 204
Petaluma, CA 94952-4262
Mailing address
204 G St
Suite 204
Petaluma, CA 94952-4262
Phone (707) 782-1222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11707211 | Other | CA | CAQH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 9, 2024 through Jan 9, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC31242 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309305600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309305600000",
"number": "1124315148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 G ST",
"address_2": "SUITE 204",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949524262",
"telephone_number": "707-782-1222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "204 G ST",
"address_2": "SUITE 204",
"city": "PETALUMA",
"state": "CA",
"postal_code": "949524262",
"telephone_number": "707-782-1222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SILVERMAN",
"first_name": "JILL",
"middle_name": "ANN",
"credential": "M.F.T.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-06-29",
"last_updated": "2011-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC31242",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11707211",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Petaluma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.