Provider Demographics
NPI:1801028568
Name:SMITH, FREDRICK SCOTT
Entity Type:Individual
Prefix:MR
First Name:FREDRICK
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 VIA VERDE DR
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-3745
Mailing Address - Country:US
Mailing Address - Phone:909-641-0846
Mailing Address - Fax:
Practice Address - Street 1:1704 VIA VERDE DR
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92377-3745
Practice Address - Country:US
Practice Address - Phone:909-641-0846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health