Provider Demographics
NPI:1548386436
Name:SMART, ALICIA E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:E
Last Name:SMART
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 1:895 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-1916
Mailing Address - Country:US
Mailing Address - Phone:415-459-5206
Mailing Address - Fax:415-459-5262
Practice Address - Street 1:895 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-1916
Practice Address - Country:US
Practice Address - Phone:415-459-5206
Practice Address - Fax:415-459-5262
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAPSY 24516103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
9357OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
9357OtherSFGH INTERNAL USE ONLY