MEDICARE: SINEAD SMYTH 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	MFC 36400	CA

General Provider Information

NPI Number	:	1528275575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SINEAD SMYTH LMFT

Provider Business Mailing Address
First Line	:	2515 SANTA CLARA AVE
Second Line	:	STE. 210
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4660
Country	:	US
Telephone Number	:	510-748-0640
Fax Number	:	510-748-0682

Provider Business Practice Location Address
First Line	:	2515 SANTA CLARA AVE
Second Line	:	STE. 210
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4660
Country	:	US
Telephone Number	:	510-748-0640
Fax Number	:	510-748-0682

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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