Healthcare Provider Details

I. General information

NPI: 1235656463
Provider Name (Legal Business Name): LAURA SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 N HOOVER ST
LOS ANGELES CA
90004
US

IV. Provider business mailing address

437 N HOOVER ST
LOS ANGELES CA
90004-2306
US

V. Phone/Fax

Practice location:
  • Phone: 951-529-4452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: