Provider Demographics
NPI:1174070924
Name:SMITH, MAUREEN Y (LMFT)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:Y
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:SAN GERONIMO
Mailing Address - State:CA
Mailing Address - Zip Code:94963-0426
Mailing Address - Country:US
Mailing Address - Phone:415-488-4277
Mailing Address - Fax:
Practice Address - Street 1:11100 SAN PABLO AVE STE 205
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-2100
Practice Address - Country:US
Practice Address - Phone:415-328-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist