1134541998 NPI number — MARTA SIMOPOULOS PICKENS PH.D., CLINICAL PSYC

Table of content: MARTA SIMOPOULOS PICKENS PH.D., CLINICAL PSYC (NPI 1134541998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134541998 NPI number — MARTA SIMOPOULOS PICKENS PH.D., CLINICAL PSYC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SIMOPOULOS PICKENS
Provider First Name:
MARTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D., CLINICAL PSYC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SIMOPOULOS
Provider Other First Name:
MARTA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134541998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4944 WINDPLAY DR.
Provider Second Line Business Mailing Address:
ST. 320
Provider Business Mailing Address City Name:
EL DORADO HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-933-4195
Provider Business Mailing Address Fax Number:
530-672-2418

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4944 WINDPLAY DR.
Provider Second Line Business Practice Location Address:
ST. 320
Provider Business Practice Location Address City Name:
EL DORADO HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-933-4195
Provider Business Practice Location Address Fax Number:
530-672-2418
Provider Enumeration Date:
01/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY19844 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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