Provider Demographics
NPI:1124266242
Name:SMITH, SANDRA HAMILTINE (PHD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:HAMILTINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 CLAY ST
Mailing Address - Street 2:600
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1425
Mailing Address - Country:US
Mailing Address - Phone:510-562-7146
Mailing Address - Fax:510-562-7164
Practice Address - Street 1:1300 CLAY ST
Practice Address - Street 2:600
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1425
Practice Address - Country:US
Practice Address - Phone:510-562-7146
Practice Address - Fax:510-562-7164
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA155750100OtherUS DEPARTMENT OF LABOR OWCP