Provider Demographics
NPI:1669777678
Name:SARACAY -SMITH, IVONNE
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:SARACAY -SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IVONNE
Other - Middle Name:
Other - Last Name:SARACAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5633 TOPANGA CANYON BLVD APT 310
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6449
Mailing Address - Country:US
Mailing Address - Phone:805-582-4082
Mailing Address - Fax:
Practice Address - Street 1:1227 E LOS ANGELES AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2871
Practice Address - Country:US
Practice Address - Phone:805-582-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMFT 81326106H00000X
CAIMFT81326106H00000X
CALMFT119395106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist