Elizabeth Amelia Smith, PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

31358 Issued in CA

Practice address

3737 Moraga Ave Ste A203
San Diego, CA 92117-5491

Phone

(619) 363-1920

NPI assigned

Dec 5, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kendra Penski Licensed Clinical Social Worker Inc

  • Clinical Social Worker
  • San Diego, CA
  • NPI 1548700891
  NPD

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

{
    "created_epoch": "1512432000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599436800000",
    "number": "1497260020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16164",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921766164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 MORAGA AVE STE A203",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921175491",
            "telephone_number": "619-363-1920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "55 Lake Ave N",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016550002",
            "country_code": "US",
            "telephone_number": "508-334-2731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ELIZABETH",
        "middle_name": "AMELIA",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-05",
        "last_updated": "2020-09-07",
        "certification_date": "2020-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "31358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane Marie Smith, P.T.A.
• Duke J Smith
• Edward Albert Smith
• Eldridge Charles Smith, PERIODONTIST DDS
• Eleanor Joan Smith, PHARM.D.
• Elleanor Grace Smith, ND
• Emilie Anne Smith, PHARMD
• Emily A Smith, MOT, OTR/L
• Emily Anne Smith
• Emily Harper Smith, PT, DPT

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 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.