Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | 22832 | CA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 22832 | CA |
N | 103TA0700X | Adult Development & Aging Psychologist | 22832 | CA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 22832 | CA |
N | 103G00000X | Clinical Psychologist | 22832 | CA |
N | 103TC0700X | Clinical Psychologist | 22832 | CA |
Y | 103G00000X | Clinical Psychologist | PSY22832 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY22832 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 22832 | CA |
N | 103TP2701X | Group Psychotherapist | 22832 | CA |
NPI | 1043532088 |
---|---|
Provider Name | Dr. Stephen J. Smith |
First Address | Burbank, CA 91505 |
Second Address | Burbank, CA 91505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2010 |
Last Update Date | 19/05/2016 |