Provider Demographics
NPI:1447749924
Name:SMITH, LAURA ELENA (MS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ELENA
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14895 E 14TH ST STE 465
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2989
Mailing Address - Country:US
Mailing Address - Phone:510-346-7100
Mailing Address - Fax:510-346-7101
Practice Address - Street 1:14895 E 14TH ST STE 465
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2989
Practice Address - Country:US
Practice Address - Phone:510-346-7100
Practice Address - Fax:510-346-7101
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst