Healthcare Provider Details

I. General information

NPI: 1871310961
Provider Name (Legal Business Name): JENNIFER RICHELLE SMITH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 EL CAMINO REAL STE 120 PMB 1487
MENLO PARK CA
94025-4844
US

IV. Provider business mailing address

700 EL CAMINO REAL STE 120 PMB 1487
MENLO PARK CA
94025-4844
US

V. Phone/Fax

Practice location:
  • Phone: 415-322-7579
  • Fax:
Mailing address:
  • Phone: 415-322-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number146396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: