Provider Demographics
NPI:1023563483
Name:SMITH, SERENA MARIE (AMFT, MA)
Entity Type:Individual
Prefix:MRS
First Name:SERENA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:AMFT, MA
Other - Prefix:MS
Other - First Name:SERENA
Other - Middle Name:MARIE
Other - Last Name:HAWORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFTI, MA
Mailing Address - Street 1:PO BOX 5643
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-1643
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2523 EL PORTAL DR
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3305
Practice Address - Country:US
Practice Address - Phone:510-215-3742
Practice Address - Fax:510-215-3741
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist