Healthcare Provider Details

I. General information

NPI: 1700140837
Provider Name (Legal Business Name): PHILIPPA C.G. SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 PAVILION PKWY APT 8104
TRACY CA
95304-9591
US

IV. Provider business mailing address

2725 PAVILION PKWY APT 8104
TRACY CA
95304-9591
US

V. Phone/Fax

Practice location:
  • Phone: 916-705-4430
  • Fax:
Mailing address:
  • Phone: 916-705-4430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19524
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: