Healthcare Provider Details

I. General information

NPI: 1619653177
Provider Name (Legal Business Name): NAYELI SMITH MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NAYELI GONZALEZ

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 PARKS AVE APT 17
LA MESA CA
91941-6164
US

IV. Provider business mailing address

8697 LA MESA BLVD # C PMB 145
LA MESA CA
91942
US

V. Phone/Fax

Practice location:
  • Phone: 760-886-2440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128100
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: