Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | CA | |
N | 103T00000X | Psychologist | CA | |
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1033474994 |
---|---|
Provider Name | Dr. Simone Anita Smith |
First Address | Los Angeles, CA 90034-3740 |
Second Address | Los Angeles, CA 90034-3710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2012 |
Last Update Date | 24/08/2020 |