Healthcare Provider Details

I. General information

NPI: 1326437641
Provider Name (Legal Business Name): SEAN CHRISTOPHER SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 TELEGRAPH AVE STE 515
BERKELEY CA
94705-1151
US

IV. Provider business mailing address

170 9TH ST
SAN FRANCISCO CA
94103-2603
US

V. Phone/Fax

Practice location:
  • Phone: 734-474-8184
  • Fax:
Mailing address:
  • Phone: 415-777-0333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number97830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: