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NPI Code Detail

MEDICARE: MR. STAN SMITH SMITH LCSW

MEDICARE: MR. STAN SMITH 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
11041C0700XClinical Social Worker91008CA
21041C0700XClinical Social WorkerLCSW91008CA

General Provider Information

NPI Number : 1174146351
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. STAN SMITH SMITH LCSW
Provider Business Mailing Address
First Line : 17223 OROZCO ST
Second Line :
City : GRANADA HILLS
State : CA
Zip : 91344-1132
Country : US
Telephone Number : 818-632-6154
Fax Number :
Provider Business Practice Location Address
First Line : 330 RAYMONDALE DR APT 2
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2118
Country : US
Telephone Number : 818-632-6154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2020
Last Update Date : 05/03/2025

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Directions to “ MR. STAN SMITH SMITH LCSW” Practice Location

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