Provider Demographics
NPI:1124225198
Name:SMITH, SERI ANNETTE (MS, NCSP)
Entity Type:Individual
Prefix:
First Name:SERI
Middle Name:ANNETTE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23305 N 70TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310-5858
Mailing Address - Country:US
Mailing Address - Phone:623-362-2237
Mailing Address - Fax:
Practice Address - Street 1:23305 N 70TH LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310-5858
Practice Address - Country:US
Practice Address - Phone:623-362-2237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool