Provider Demographics
NPI:1174146351
Name:SMITH, STAN SMITH (LCSW)
Entity type:Individual
Prefix:MR
First Name:STAN
Middle Name:SMITH
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17223 OROZCO ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1132
Mailing Address - Country:US
Mailing Address - Phone:818-632-6154
Mailing Address - Fax:
Practice Address - Street 1:330 RAYMONDALE DR APT 2
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-2118
Practice Address - Country:US
Practice Address - Phone:818-632-6154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-22
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA910081041C0700X
CALCSW910081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical