Healthcare Provider Details

I. General information

NPI: 1043532088
Provider Name (Legal Business Name): STEPHEN J. SMITH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 WEST OLIVE AVENUE 5TH FLOOR
BURBANK CA
91505
US

IV. Provider business mailing address

2600 WEST OLIVE AVENUE 5TH FLOOR
BURBANK CA
91505
US

V. Phone/Fax

Practice location:
  • Phone: 818-391-9140
  • Fax:
Mailing address:
  • Phone: 818-391-9140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number22832
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number22832
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number22832
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number22832
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number22832
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number22832
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number22832
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22832
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: