Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY 12502 | CA |
N | 103T00000X | Psychologist | PSY 12502 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY12502 | CA |
N | 103G00000X | Clinical Psychologist | PSY 12502 | CA |
N | 103TC0700X | Clinical Psychologist | PSY 12502 | CA |
N | 103TF0000X | Family Psychologist | PSY 12502 | CA |
NPI | 1073645297 |
---|---|
Provider Name | Dr. Candia Kathryn Smith |
First Address | Orinda, CA 94563-3097 |
Second Address | Orinda, CA 94563-3097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |