Healthcare Provider Details

I. General information

NPI: 1154457364
Provider Name (Legal Business Name): JOANNA KAREN SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 ASHBY AVE STE 105
BERKELEY CA
94705-2439
US

IV. Provider business mailing address

3030 ASHBY AVE STE 105
BERKELEY CA
94705-2439
US

V. Phone/Fax

Practice location:
  • Phone: 510-704-8476
  • Fax:
Mailing address:
  • Phone: 510-704-8476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 9586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: