Provider Demographics
NPI:1942498738
Name:SMITH, SOPHANA (MASTER OF SOCIAL WOR)
Entity Type:Individual
Prefix:MRS
First Name:SOPHANA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MASTER OF SOCIAL WOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4141
Mailing Address - Country:US
Mailing Address - Phone:626-691-1327
Mailing Address - Fax:
Practice Address - Street 1:532 E COLORADO BLVD
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2044
Practice Address - Country:US
Practice Address - Phone:626-229-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical