Provider Demographics
NPI:1063741601
Name:SMITH, ALEXIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1442A WALNUT ST
Mailing Address - Street 2:#394
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1405
Mailing Address - Country:US
Mailing Address - Phone:510-207-9890
Mailing Address - Fax:
Practice Address - Street 1:1855 SAN MIGUEL DR
Practice Address - Street 2:STE 23
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5290
Practice Address - Country:US
Practice Address - Phone:925-324-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28050103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist