Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | LEP2724 | CA |
NPI | 1073080834 |
---|---|
Provider Name | Kevin Read Smith |
First Address | Merced, CA 95340-3723 |
Second Address | Merced, CA 95340-3723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2018 |
Last Update Date | 30/10/2018 |