MEDICARE: JASMINE DA'VIONNE SMITH LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	88824	CA

General Provider Information

NPI Number	:	1164895769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE DA'VIONNE SMITH LCSW

Provider Business Mailing Address
First Line	:	PO BOX 2845
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90231-2845
Country	:	US
Telephone Number	:	323-631-1291
Fax Number	:

Provider Business Practice Location Address
First Line	:	3705 W PICO BLVD # 640
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-3451
Country	:	US
Telephone Number	:	323-688-5674
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2015
Last Update Date	:	03/26/2020

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