Provider Demographics
NPI:1922031087
Name:CRAIG-SMITH, MARCIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:CRAIG-SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10556 COMBIE RD # 6627
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8908
Mailing Address - Country:US
Mailing Address - Phone:530-320-6577
Mailing Address - Fax:530-268-3576
Practice Address - Street 1:3272 FORTUNE CT
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-7847
Practice Address - Country:US
Practice Address - Phone:530-320-6577
Practice Address - Fax:530-268-3576
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15483103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY154830Medicaid
CA0PL154831Medicare ID - Type Unspecified
CAPSY154830Medicaid
CA0PL154830Medicare ID - Type Unspecified