Provider Demographics
NPI:1780208801
Name:ZEQUEIRA, IVY (LMFT)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:
Last Name:ZEQUEIRA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 E MARIPOSA ST APT F
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-2374
Mailing Address - Country:US
Mailing Address - Phone:626-840-6515
Mailing Address - Fax:
Practice Address - Street 1:130 S EUCLID AVE STE 2
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2471
Practice Address - Country:US
Practice Address - Phone:626-714-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty