Provider Demographics
NPI:1821207168
Name:SMITH, SANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 HOPYARD RD
Mailing Address - Street 2:#103
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8562
Mailing Address - Country:US
Mailing Address - Phone:925-462-3010
Mailing Address - Fax:
Practice Address - Street 1:3730 HOPYARD RD
Practice Address - Street 2:#103
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8562
Practice Address - Country:US
Practice Address - Phone:925-462-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical