Healthcare Provider Details

I. General information

NPI: 1922345982
Provider Name (Legal Business Name): SUZANNE SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N BRAND BLVD STE 366
GLENDALE CA
91203-4427
US

IV. Provider business mailing address

10559 PINYON AVE
TUJUNGA CA
91042-1514
US

V. Phone/Fax

Practice location:
  • Phone: 818-288-3460
  • Fax: 866-912-7569
Mailing address:
  • Phone: 818-288-3460
  • Fax: 866-912-7569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: