Provider Demographics
NPI:1053820191
Name:SIMAR, DEANA (LMFT)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:SIMAR
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DEANE
Other - Middle Name:RAIN
Other - Last Name:MARIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3100 REDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-2517
Mailing Address - Country:US
Mailing Address - Phone:650-521-2073
Mailing Address - Fax:
Practice Address - Street 1:1132 MCKENDRIE ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1406
Practice Address - Country:US
Practice Address - Phone:650-521-2073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77578106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE