Provider Demographics
NPI:1972633709
Name:LA PAY, SIMONE MARIE (MFT)
Entity Type:Individual
Prefix:
First Name:SIMONE
Middle Name:MARIE
Last Name:LA PAY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17369 VIA LA JOLLA
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-3541
Mailing Address - Country:US
Mailing Address - Phone:510-276-9020
Mailing Address - Fax:
Practice Address - Street 1:1900 EMBARCADERO
Practice Address - Street 2:SUITE 208
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606-5231
Practice Address - Country:US
Practice Address - Phone:510-346-1092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist