Provider Demographics
NPI:1598981599
Name:SMITH, STEFANIE FLORENCE (PHD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:FLORENCE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CALISTOGA RD # 333
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-3702
Mailing Address - Country:US
Mailing Address - Phone:415-418-4456
Mailing Address - Fax:415-975-0853
Practice Address - Street 1:17000 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3242
Practice Address - Country:US
Practice Address - Phone:415-418-4456
Practice Address - Fax:415-975-0853
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical