Provider Demographics
NPI:1447386065
Name:SMITH, MICHAEL K (PHD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N CALIFORNIA AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3965
Mailing Address - Country:US
Mailing Address - Phone:650-325-3538
Mailing Address - Fax:
Practice Address - Street 1:145 N CALIFORNIA AVE STE 2
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3965
Practice Address - Country:US
Practice Address - Phone:650-325-3538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14832103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist