MEDICARE: MRS. NELL YSABEL SMITH MA, BEH SCIENCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	104100000X	Social Worker
2	171M00000X	Case Manager/Care Coordinator
3	172V00000X	Community Health Worker	CA

General Provider Information

NPI Number	:	1689478687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NELL YSABEL SMITH MA, BEH SCIENCE

Provider Business Mailing Address
First Line	:	3001 E TAHQUITZ CANYON WAY # 104103
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6982
Country	:	US
Telephone Number	:	760-202-4308
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 E TAHQUITZ CANYON WAY STE 103
Second Line	:
City	:	PALM SPRINGS
State	:	CA
Zip	:	92262-6900
Country	:	US
Telephone Number	:	760-202-4308
Fax Number	:

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

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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