Provider Demographics
NPI:1447389275
Name:SMID, BARTHOLOMEW MATIAS
Entity Type:Individual
Prefix:MR
First Name:BARTHOLOMEW
Middle Name:MATIAS
Last Name:SMID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22505 WOODROE AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3410
Mailing Address - Country:US
Mailing Address - Phone:510-798-1986
Mailing Address - Fax:
Practice Address - Street 1:22505 WOODROE AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3410
Practice Address - Country:US
Practice Address - Phone:510-798-1986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD2124716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health