MEDICARE: PHILIPPA C.G. 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	19524	CA

General Provider Information

NPI Number	:	1700140837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILIPPA C.G. SMITH LCSW

Provider Business Mailing Address
First Line	:	2725 PAVILION PKWY APT 8104
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95304-9591
Country	:	US
Telephone Number	:	916-705-4430
Fax Number	:

Provider Business Practice Location Address
First Line	:	2725 PAVILION PKWY APT 8104
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95304-9591
Country	:	US
Telephone Number	:	916-705-4430
Fax Number	:

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

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	05/11/2026

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