Healthcare Provider Details

I. General information

NPI: 1184815433
Provider Name (Legal Business Name): GRACE ELIZABETH SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2198 6TH ST SUITE 100
BERKELEY CA
94710-2233
US

IV. Provider business mailing address

2198 6TH ST SUITE 100
BERKELEY CA
94710-2233
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1112
  • Fax: 510-848-4445
Mailing address:
  • Phone: 510-848-1112
  • Fax: 510-848-4445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS22659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: