Basic Information
| Provider Information | |||||||||
| NPI: | 1669777678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SARACAY -SMITH | ||||||||
| FirstName: | IVONNE | ||||||||
| MiddleName: | |||||||||
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| OtherLastName: | SARACAY | ||||||||
| OtherFirstName: | IVONNE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5633 TOPANGA CANYON BLVD APT 310 | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913676449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055824082 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1227 E LOS ANGELES AVE | ||||||||
| Address2: | |||||||||
| City: | SIMI VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930652871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055824080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/21/2011 | ||||||||
| LastUpdateDate: | 07/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMFT 81326 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | IMFT81326 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT119395 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.