Provider Demographics
NPI:1518004399
Name:SMITH, DINA CLARICE (MSW, CATC IV)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:CLARICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, CATC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 12TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1297
Mailing Address - Country:US
Mailing Address - Phone:415-358-2739
Mailing Address - Fax:415-554-1914
Practice Address - Street 1:68 12TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1297
Practice Address - Country:US
Practice Address - Phone:415-358-2739
Practice Address - Fax:415-554-1914
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35246104100000X
CA071429IV101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)