MEDICARE: PA'CJON 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	LCSW103634	CA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629528898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PA'CJON SMITH LCSW

Provider Business Mailing Address
First Line	:	8929 S SEPULVEDA BLVD STE 410
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3634
Country	:	US
Telephone Number	:	424-317-6800
Fax Number	:

Provider Business Practice Location Address
First Line	:	8929 S SEPULVEDA BLVD STE 410
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3634
Country	:	US
Telephone Number	:	424-317-6800
Fax Number	:

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

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	01/10/2023

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Directions to “ PA'CJON SMITH LCSW” Practice Location

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