Provider Demographics
NPI:1114137254
Name:PAEZ-ARROYO, ASCENETH (MFT)
Entity Type:Individual
Prefix:
First Name:ASCENETH
Middle Name:
Last Name:PAEZ-ARROYO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39155 LIBERTY ST STE E500
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1516
Mailing Address - Country:US
Mailing Address - Phone:510-574-2118
Mailing Address - Fax:
Practice Address - Street 1:39155 LIBERTY ST STE E500
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1516
Practice Address - Country:US
Practice Address - Phone:510-574-2118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 45156106H00000X
CA47072106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist