MEDICARE: DR. WENDY BENJAMIN SMITH PH.D., 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	LCS 4747	CA
2	1041C0700X	Clinical Social Worker	MFT 6565	CA

General Provider Information

NPI Number	:	1871714212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WENDY BENJAMIN SMITH PH.D., LCSW

Provider Business Mailing Address
First Line	:	12011 SAN VICENTE BLVD
Second Line	:	SUITE 408
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4926
Country	:	US
Telephone Number	:	310-471-6607
Fax Number	:	310-476-3529

Provider Business Practice Location Address
First Line	:	12011 SAN VICENTE BLVD
Second Line	:	SUITE 408
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4926
Country	:	US
Telephone Number	:	310-471-6607
Fax Number	:	310-476-3529

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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