MEDICARE: MAUREEN Y SMITH LMFT

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	106H00000X	Marriage & Family Therapist	111248	CA

General Provider Information

NPI Number	:	1174070924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN Y SMITH LMFT

Provider Business Mailing Address
First Line	:	PO BOX 426
Second Line	:
City	:	SAN GERONIMO
State	:	CA
Zip	:	94963-0426
Country	:	US
Telephone Number	:	415-488-4277
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 SAN PABLO AVE STE 205
Second Line	:
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2100
Country	:	US
Telephone Number	:	415-328-3202
Fax Number	:

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

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	06/25/2019

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