Provider Demographics
NPI:1851576722
Name:SIMOFF, MICHEAL (MFT)
Entity Type:Individual
Prefix:
First Name:MICHEAL
Middle Name:
Last Name:SIMOFF
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 N LAUREL AVE APT 16
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-5123
Mailing Address - Country:US
Mailing Address - Phone:323-654-0462
Mailing Address - Fax:
Practice Address - Street 1:1266 N LAUREL AVE APT 16
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5123
Practice Address - Country:US
Practice Address - Phone:323-654-0462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40910104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker