Provider Demographics
NPI:1578040341
Name:SMITH, MARY STEFANIE (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:STEFANIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15466 LOS GATOS BLVD STE 109-151
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2542
Mailing Address - Country:US
Mailing Address - Phone:408-426-0958
Mailing Address - Fax:
Practice Address - Street 1:18855 ASPESI DR
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-5209
Practice Address - Country:US
Practice Address - Phone:408-426-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-25
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107296106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist