Provider Demographics
NPI:1790100147
Name:SMITH, JUDITH (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 S HELBERTA AVE # A
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-3451
Mailing Address - Country:US
Mailing Address - Phone:310-722-8489
Mailing Address - Fax:
Practice Address - Street 1:916 SILVER SPUR RD
Practice Address - Street 2:SUITE 305A
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3810
Practice Address - Country:US
Practice Address - Phone:310-722-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50642106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist