Healthcare Provider Details

I. General information

NPI: 1063209690
Provider Name (Legal Business Name): HANNAH RAINS SMITH M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2025
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 1ST ST
BENICIA CA
94510-3217
US

IV. Provider business mailing address

1791 SOLANO AVE # F-10
BERKELEY CA
94707-2209
US

V. Phone/Fax

Practice location:
  • Phone: 415-632-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number143931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: