Provider Demographics
NPI:1942409875
Name:SMITH, ROSS SYDNEY (MS)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:SYDNEY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 W CHARLESTON RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-4103
Mailing Address - Country:US
Mailing Address - Phone:650-306-0362
Mailing Address - Fax:650-857-9676
Practice Address - Street 1:448 W CHARLESTON RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-4103
Practice Address - Country:US
Practice Address - Phone:650-306-0362
Practice Address - Fax:650-857-9676
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT#36343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist