Provider Demographics
NPI:1659065605
Name:SIMINO, MATTHEW SYLVAN (AMFT)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SYLVAN
Last Name:SIMINO
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 N SWALL DR APT 403
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1927
Mailing Address - Country:US
Mailing Address - Phone:310-467-0694
Mailing Address - Fax:
Practice Address - Street 1:116 N SWALL DR APT 403
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1927
Practice Address - Country:US
Practice Address - Phone:310-467-0694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT139739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty