MEDICARE: MATTHEW SCOTT SMITH MFT

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	40819	CA

General Provider Information

NPI Number	:	1760582514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW SCOTT SMITH MFT

Provider Business Mailing Address
First Line	:	PO BOX 5073
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94581-0073
Country	:	US
Telephone Number	:	707-628-8496
Fax Number	:

Provider Business Practice Location Address
First Line	:	2751 NAPA VALLEY CORPORATE DR
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-6216
Country	:	US
Telephone Number	:	707-628-8496
Fax Number	:

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	03/29/2022

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