MEDICARE: SOPHIA RUTH SMITH AMFT

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	149650	CA

General Provider Information

NPI Number	:	1508795717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA RUTH SMITH AMFT

Provider Business Mailing Address
First Line	:	6529 CROWN BLVD STE D
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2905
Country	:	US
Telephone Number	:	408-997-0200
Fax Number	:	408-997-0711

Provider Business Practice Location Address
First Line	:	6529 CROWN BLVD STE D
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95120-2905
Country	:	US
Telephone Number	:	408-997-0200
Fax Number	:	408-997-0711

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

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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Directions to “ SOPHIA RUTH SMITH AMFT” Practice Location

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