Provider Demographics
NPI:1003181967
Name:DE ASSIS, DAURA M (PSY)
Entity Type:Individual
Prefix:DR
First Name:DAURA
Middle Name:M
Last Name:DE ASSIS
Suffix:
Gender:F
Credentials:PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 PALM DR
Mailing Address - Street 2:# 6
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3215
Mailing Address - Country:US
Mailing Address - Phone:310-600-6583
Mailing Address - Fax:
Practice Address - Street 1:436 PALM DR
Practice Address - Street 2:# 6
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3215
Practice Address - Country:US
Practice Address - Phone:310-600-6583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15114103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical