Provider Demographics
NPI:1134933567
Name:DARSANA, SIMONE ANASTASIA
Entity type:Individual
Prefix:
First Name:SIMONE
Middle Name:ANASTASIA
Last Name:DARSANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4642 ENCINAS DR
Mailing Address - Street 2:
Mailing Address - City:LA CANADA FLT
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2227
Mailing Address - Country:US
Mailing Address - Phone:510-375-4677
Mailing Address - Fax:
Practice Address - Street 1:4642 ENCINAS DR
Practice Address - Street 2:
Practice Address - City:LA CANADA FLT
Practice Address - State:CA
Practice Address - Zip Code:91011-2227
Practice Address - Country:US
Practice Address - Phone:510-375-4677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT152430106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist