Provider Demographics
NPI:1659458909
Name:SMITH, LINDA KIMBERLY (CSWI)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:KIMBERLY
Last Name:SMITH
Suffix:
Gender:F
Credentials:CSWI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 TURTLE BAY LN
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-6551
Mailing Address - Country:US
Mailing Address - Phone:949-307-2207
Mailing Address - Fax:
Practice Address - Street 1:302 TURTLE BAY LN
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-6551
Practice Address - Country:US
Practice Address - Phone:949-307-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW133391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical