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NPI Code Detail

MEDICARE: MS. KIMBERLY ANN SMITH PSYD

MEDICARE: MS. KIMBERLY ANN SMITH PSYD
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
1103TC0700XClinical PsychologistPSY19314CA

General Provider Information

NPI Number : 1639119563
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIMBERLY ANN SMITH PSYD
Provider Business Mailing Address
First Line : 275 BECK AVE
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6804
Country : US
Telephone Number : 707-448-8398
Fax Number :
Provider Business Practice Location Address
First Line : 275 BECK AVE
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6804
Country : US
Telephone Number : 707-448-8398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2006
Last Update Date : 07/08/2007

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Directions to “ MS. KIMBERLY ANN SMITH PSYD” Practice Location

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