Provider Demographics
NPI:1346372638
Name:SMITH, TIFFANY K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53531
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90053-0531
Mailing Address - Country:US
Mailing Address - Phone:213-485-0439
Mailing Address - Fax:
Practice Address - Street 1:535 N ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3405
Practice Address - Country:US
Practice Address - Phone:213-485-0439
Practice Address - Fax:213-253-9582
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2022-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20700103TC0700X, 103TC2200X
CAPSY20700103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent