Provider Demographics
NPI:1114124856
Name:SMITH, ANTHONY EUGENE
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:EUGENE
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1546 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-3235
Mailing Address - Country:US
Mailing Address - Phone:510-383-1653
Mailing Address - Fax:510-383-1616
Practice Address - Street 1:333 HEGENBERGER RD
Practice Address - Street 2:SUITE 600
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-1420
Practice Address - Country:US
Practice Address - Phone:510-383-1653
Practice Address - Fax:510-383-1616
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor