Healthcare Provider Details

I. General information

NPI: 1154500874
Provider Name (Legal Business Name): TODD ANDREW SMITH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E FOOTHILL BLVD STE 300
PASADENA CA
91107-7102
US

IV. Provider business mailing address

897 GRANITE DR
PASADENA CA
91101-3501
US

V. Phone/Fax

Practice location:
  • Phone: 626-993-3000
  • Fax: 626-993-3084
Mailing address:
  • Phone: 626-993-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW73095
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number96468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: