Provider Demographics
NPI:1760766752
Name:SMITH, LEDA L (PSY D)
Entity Type:Individual
Prefix:DR
First Name:LEDA
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 E POLK ST # 26
Mailing Address - Street 2:
Mailing Address - City:COALINGA
Mailing Address - State:CA
Mailing Address - Zip Code:93210-2311
Mailing Address - Country:US
Mailing Address - Phone:559-354-9531
Mailing Address - Fax:559-354-9532
Practice Address - Street 1:194 E ELM AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-2800
Practice Address - Country:US
Practice Address - Phone:559-354-9531
Practice Address - Fax:559-354-9532
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22124103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical