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General NPI Number Information
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NPI Number | 1689766164
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Entity Type | Individual
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Provider Name | MARILYN VIRGINIA SMITH LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 04/18/2016
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Provider Practice Location Address
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Address Line | 2030 E 4TH ST SUITE G-152
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City | SANTA ANA
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State | CA
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Zip | 92705-3940
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Country | US
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Telephone | 949-466-3213
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Fax |
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Provider Business Mailing Address
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Address Line | 2030 E 4TH ST SUITE G-152
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City | SANTA ANA
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State | CA
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Zip | 92705-3940
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Country | US
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Telephone | 949-466-3213
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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 | 22298
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LCSW22298
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License Number State | CA
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