Provider Demographics
NPI:1720173446
Name:RENO-SMITH, DEBORAH S (MA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:S
Last Name:RENO-SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:DEBBIE
Other - Middle Name:S
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFC 47268
Mailing Address - Street 1:15095 AMARGOSA RD STE 208
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-1879
Mailing Address - Country:US
Mailing Address - Phone:760-987-8225
Mailing Address - Fax:
Practice Address - Street 1:15095 AMARGOSA RD STE 208
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1879
Practice Address - Country:US
Practice Address - Phone:760-987-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50675101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47268OtherMFC
CO2556OtherLPC
CO116OtherLAC