Provider Demographics
NPI:1669123543
Name:SMITH, DEIRDRE JONES (MS)
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:JONES
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 DEL NORTE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-8368
Mailing Address - Country:US
Mailing Address - Phone:805-320-6259
Mailing Address - Fax:
Practice Address - Street 1:1317 DEL NORTE RD STE 200
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-8368
Practice Address - Country:US
Practice Address - Phone:805-320-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor