Provider Demographics
NPI:1912360405
Name:SMITH, ALICE ROBINSON (MFT)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:ROBINSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:5028 GEARY BLVD.
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2814
Mailing Address - Country:US
Mailing Address - Phone:415-668-3904
Mailing Address - Fax:
Practice Address - Street 1:5028 GEARY BLVD.
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2814
Practice Address - Country:US
Practice Address - Phone:415-668-3904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health