1871714212 NPI number — DR. WENDY BENJAMIN SMITH PH.D., LCSW

Table of content: DR. WENDY BENJAMIN SMITH PH.D., LCSW (NPI 1871714212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871714212 NPI number — DR. WENDY BENJAMIN SMITH PH.D., LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
WENDY
Provider Middle Name:
BENJAMIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871714212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12011 SAN VICENTE BLVD
Provider Second Line Business Practice Location Address:
SUITE 408
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90049-4926
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-471-6607
Provider Business Practice Location Address Fax Number:
310-476-3529
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 4747 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: MFT 6565 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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