Provider Demographics
NPI:1144747296
Name:SMITH, MEREDITH BURNEAL (PHD CLINICAL PSYCH)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:BURNEAL
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 E GRAND AVE STE 940
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-5153
Mailing Address - Country:US
Mailing Address - Phone:909-499-7009
Mailing Address - Fax:
Practice Address - Street 1:1960 E GRAND AVE STE 940
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5153
Practice Address - Country:US
Practice Address - Phone:909-499-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical