Andrew Roy Smith

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY15081 Issued in CA

Practice address

7510 Shoreline Dr
Ste a-5
Stockton, CA 95219

Phone

(209) 477-1717

Fax

(509) 477-1717

NPI assigned

Aug 23, 2006

Last updated

Sep 29, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601337600000",
    "number": "1225144967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7510 SHORELINE DR",
            "address_2": "STE A-5",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95219",
            "telephone_number": "209-477-1717",
            "fax_number": "509-477-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7510 SHORELINE DR",
            "address_2": "STE A-5",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "95219",
            "telephone_number": "209-477-1717",
            "fax_number": "509-477-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ANDREW",
        "middle_name": "ROY",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "15081",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY15081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marie Smith Butler
• Samyel Smith-Allen
• Jacqueline Alice Smith-Ratliff, LMFT
• Alliyah Monique Smith
• Anamarie Smith
• Ashley Denise Smith
• Bridgett Denise Smith, RRT
• Cassidy Jordan Smith
• Cecily Smith
• Charlene Marie Smith

• Psychologist in Stockton, CA
• Providers in Stockton, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.