Provider Demographics
NPI:1154457364
Name:SMITH, JOANNA KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:KAREN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 ASHBY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2439
Mailing Address - Country:US
Mailing Address - Phone:510-704-8476
Mailing Address - Fax:
Practice Address - Street 1:3030 ASHBY AVE STE 105
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2439
Practice Address - Country:US
Practice Address - Phone:510-704-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 95861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical