Healthcare Provider Details

I. General information

NPI: 1609297357
Provider Name (Legal Business Name): DAWN ELIZABETH SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2013
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD BLDG 98
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

5342 DUDLEY BLVD BLDG 98
MCCLELLAN CA
95652-1012
US

V. Phone/Fax

Practice location:
  • Phone: 916-843-9412
  • Fax:
Mailing address:
  • Phone: 916-843-9412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-33420
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: