Provider Demographics
NPI:1679611180
Name:LARA, IRMA MARGARITA (LMFCC)
Entity Type:Individual
Prefix:MS
First Name:IRMA
Middle Name:MARGARITA
Last Name:LARA
Suffix:
Gender:F
Credentials:LMFCC
Other - Prefix:MRS
Other - First Name:IRMA
Other - Middle Name:MARGARITA
Other - Last Name:DONOHUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFC
Mailing Address - Street 1:1972 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126
Mailing Address - Country:US
Mailing Address - Phone:408-296-0936
Mailing Address - Fax:408-279-4849
Practice Address - Street 1:1972 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126
Practice Address - Country:US
Practice Address - Phone:408-296-0936
Practice Address - Fax:408-279-4849
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFC13374103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist