Provider Demographics
NPI:1720142540
Name:SIMON, LINDA M (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:M
Last Name:SIMON
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19725 SHERMAN WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91306
Mailing Address - Country:US
Mailing Address - Phone:818-709-4913
Mailing Address - Fax:818-709-4939
Practice Address - Street 1:19725 SHERMAN WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91306
Practice Address - Country:US
Practice Address - Phone:818-709-4913
Practice Address - Fax:818-709-4939
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC19765OtherMFT LICENCE