=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114124856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. ANTHONY EUGENE SMITH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 HEGENBERGER RD SUITE 600
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-1420
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-383-1653
-----------------------------------------------------
Fax | 510-383-1616
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1546 VAN DYKE AVE
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94124-3235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-383-1653
-----------------------------------------------------
Fax | 510-383-1616
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------