Provider Demographics
NPI:1346234887
Name:SIM, LYNETTE PAMELA (MSW)
Entity Type:Individual
Prefix:MISS
First Name:LYNETTE
Middle Name:PAMELA
Last Name:SIM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 SANTA MONICA BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1748
Mailing Address - Country:US
Mailing Address - Phone:310-394-7484
Mailing Address - Fax:310-823-1493
Practice Address - Street 1:1421 SANTA MONICA BLVD
Practice Address - Street 2:STE 103
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1748
Practice Address - Country:US
Practice Address - Phone:310-394-7484
Practice Address - Fax:310-823-1493
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS56331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SW5633Medicare ID - Type Unspecified