MEDICARE: DR. ALICIA E SMART PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	103TC0700X	Clinical Psychologist	PSY 24516	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9357	OTHER		CBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
2	9357	OTHER		SFGH INTERNAL USE ONLY

General Provider Information

NPI Number	:	1548386436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALICIA E SMART PSYD

Provider Business Mailing Address
First Line	:	895 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-1916
Country	:	US
Telephone Number	:	415-459-5206
Fax Number	:	415-459-5262

Provider Business Practice Location Address
First Line	:	895 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-1916
Country	:	US
Telephone Number	:	415-459-5206
Fax Number	:	415-459-5262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/05/2016

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