Provider Demographics
NPI:1740201235
Name:SMITH, MICHAEL JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ROOSEVELT WAY
Mailing Address - Street 2:#3
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-1433
Mailing Address - Country:US
Mailing Address - Phone:415-310-8873
Mailing Address - Fax:
Practice Address - Street 1:1304 CASTRO ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3683
Practice Address - Country:US
Practice Address - Phone:415-310-8873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20563103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL20563OtherBLUE SHIELD OF CA
CAPSY20563OtherMEDI-CAL
CAOPL20563OtherBLUE SHIELD OF CA