Provider Demographics
NPI:1184182560
Name:SMITH, PAULA (ACSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SANTA RITA PL
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-1948
Mailing Address - Country:US
Mailing Address - Phone:951-797-3166
Mailing Address - Fax:
Practice Address - Street 1:532 SANTA RITA PL
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-1948
Practice Address - Country:US
Practice Address - Phone:951-797-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW90702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health