Provider Demographics
NPI:1073309753
Name:SMITH, AMY MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S REINO RD # 192
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4269
Mailing Address - Country:US
Mailing Address - Phone:805-203-3743
Mailing Address - Fax:
Practice Address - Street 1:501 S REINO RD # 192
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-4269
Practice Address - Country:US
Practice Address - Phone:805-203-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3145103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist