Provider Demographics
NPI:1134541998
Name:SIMOPOULOS PICKENS, MARTA (PHD, CLINICAL PSYC)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:SIMOPOULOS PICKENS
Suffix:
Gender:F
Credentials:PHD, CLINICAL PSYC
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:MARIE
Other - Last Name:SIMOPOULOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4944 WINDPLAY DR.
Mailing Address - Street 2:ST. 320
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95672
Mailing Address - Country:US
Mailing Address - Phone:916-933-4195
Mailing Address - Fax:530-672-2418
Practice Address - Street 1:4944 WINDPLAY DR.
Practice Address - Street 2:ST. 320
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95672
Practice Address - Country:US
Practice Address - Phone:916-933-4195
Practice Address - Fax:530-672-2418
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical