Basic Information
| Provider Information | |||||||||
| NPI: | 1932564960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1270 S ALFRED ST | ||||||||
| Address2: | PO BOX 352351 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900359998 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 GOODRICH BLVD | ||||||||
| Address2: | |||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900225103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238329795 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2015 | ||||||||
| LastUpdateDate: | 09/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 91212 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | ASW 69160 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.