Provider Demographics
NPI:1285041145
Name:POUPENEY, PADDY ROSE (MFT)
Entity Type:Individual
Prefix:MS
First Name:PADDY
Middle Name:ROSE
Last Name:POUPENEY
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 1:21 FRANCISCA DR
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-1583
Mailing Address - Country:US
Mailing Address - Phone:925-209-6515
Mailing Address - Fax:
Practice Address - Street 1:21 FRANCISCA DR
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-1583
Practice Address - Country:US
Practice Address - Phone:925-209-6515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 36346106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist