Provider Demographics
NPI:1780083386
Name:SMART, LEAN LIBRANDO (LPCC)
Entity type:Individual
Prefix:
First Name:LEAN
Middle Name:LIBRANDO
Last Name:SMART
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23573 ELIZABETH LN
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6057
Mailing Address - Country:US
Mailing Address - Phone:951-290-8225
Mailing Address - Fax:
Practice Address - Street 1:29995 TECHNOLOGY DR
Practice Address - Street 2:103
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2632
Practice Address - Country:US
Practice Address - Phone:951-290-8225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3585101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional