Provider Demographics
NPI:1073080834
Name:SMITH, KEVIN READ (LEP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:READ
Last Name:SMITH
Suffix:
Gender:M
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-3723
Mailing Address - Country:US
Mailing Address - Phone:209-385-6649
Mailing Address - Fax:
Practice Address - Street 1:444 W 23RD ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-3723
Practice Address - Country:US
Practice Address - Phone:209-385-6649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP2724103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool