Stephen Smith
Individual provider Active NPI Counselor · Penngrove, CA
NPI 1043628829 · NPPES record last updated Jul 24, 2014
Key facts
- NPI
- 1043628829
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- Practice address
- 520 Orchard LN
Penngrove, CA 94951-9659 - Phone
- (707) 792-1834
- NPI assigned
- Jul 24, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | Yes |
Addresses
Primary practice location
520 Orchard LN
Penngrove, CA 94951-9659
Mailing address
365 Kuck LN
Petaluma, CA 94952-9606
Phone (707) 795-6954
Other providers in Penngrove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.