Provider Demographics
NPI:1740803709
Name:SMITH, MEALANI MARIE (ASCW)
Entity type:Individual
Prefix:
First Name:MEALANI
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:ASCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:328 YATES DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4705
Mailing Address - Country:US
Mailing Address - Phone:707-494-6194
Mailing Address - Fax:
Practice Address - Street 1:1023 4TH ST STE D
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4310
Practice Address - Country:US
Practice Address - Phone:707-494-6194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CAASW845681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical