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General NPI Number Information
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NPI Number | 1972048940
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Entity Type | Individual
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Provider Name | STEPHANIE MICHELLE SMITH PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 12/30/2016
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 6600 BRUCEVILLE RD PEDIATRICS A
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City | SACRAMENTO
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State | CA
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Zip | 95823-4671
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Country | US
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Telephone | 443-910-7760
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Fax |
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Provider Business Mailing Address
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Address Line | 9130 NOLAN ST APT 2016
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City | ELK GROVE
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State | CA
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Zip | 95758-7501
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Country | US
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Telephone |
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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 | PSY 28703
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License Number State | CA
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