Healthcare Provider Details

I. General information

NPI: 1063741601
Provider Name (Legal Business Name): ALEXIS SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 SAN MIGUEL DR STE 23
WALNUT CREEK CA
94596-5290
US

IV. Provider business mailing address

1442A WALNUT ST #394
BERKELEY CA
94709-1405
US

V. Phone/Fax

Practice location:
  • Phone: 925-324-1593
  • Fax:
Mailing address:
  • Phone: 510-207-9890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number28050
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number28050
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: