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General NPI Number Information
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NPI Number | 1629335054
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Entity Type | Organization
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Legal Business Name | MICHELLE B SMITH PSYD INC
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/23/2012
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Provider Practice Location Address
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Address Line | 11911 SAN VICENTE BLVD SUITE 270
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City | LOS ANGELES
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State | CA
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Zip | 90049-5086
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Country | US
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Telephone | 310-663-6638
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Fax |
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Provider Business Mailing Address
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Address Line | 11911 SAN VICENTE BLVD SUITE 270
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City | LOS ANGELES
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State | CA
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Zip | 90049-5086
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Country | US
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Telephone | 310-663-6638
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE S. BILOTTA-SMITH
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Credential | PSYD
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Telephone | 310-663-6638
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 24756
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License Number State | CA
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