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General NPI Number Information
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NPI Number | 1215378229
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Entity Type | Individual
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Provider Name | DIADRA IMANI SMITH LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 2512 ARTESIA BLVD
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3264
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Country | US
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Telephone | 562-277-1965
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 VENICE BLVD APT 301
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City | VENICE
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State | CA
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Zip | 90291-5933
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Country | US
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Telephone | 973-420-4669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 124026
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License Number State | CA
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