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General NPI Number Information
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NPI Number | 1689962706
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Entity Type | Individual
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Provider Name | NICOLE SMITH PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2011
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 3400 MALCOLM AVE
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City | OAKLAND
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State | CA
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Zip | 94605-5353
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Country | US
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Telephone | 510-577-9577
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Fax |
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Provider Business Mailing Address
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Address Line | 3093 BROADWAY UNIT 343
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City | OAKLAND
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State | CA
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Zip | 94611-5783
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Country | US
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Telephone | 847-567-0886
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 31458
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License Number State | CA
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