Provider Demographics
NPI:1699837757
Name:SMITH, NINA GINSBERG (MFT)
Entity Type:Individual
Prefix:MS
First Name:NINA
Middle Name:GINSBERG
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MASON ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-4612
Mailing Address - Country:US
Mailing Address - Phone:707-447-3880
Mailing Address - Fax:707-447-3888
Practice Address - Street 1:555 MASON ST
Practice Address - Street 2:SUITE 260
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-4612
Practice Address - Country:US
Practice Address - Phone:707-447-3880
Practice Address - Fax:707-447-3888
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist