Provider Demographics
NPI:1659409027
Name:SMITH, AMY ANN (LCSW, MSW, BSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW, MSW, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 15353
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95851-0353
Mailing Address - Country:US
Mailing Address - Phone:916-758-8688
Mailing Address - Fax:916-848-3350
Practice Address - Street 1:601 UNIVERSITY AVE STE 222
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6744
Practice Address - Country:US
Practice Address - Phone:916-758-8688
Practice Address - Fax:916-848-3350
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA64662OtherCA BBS