Provider Demographics
NPI:1306153283
Name:SMITH, DEBORAH L (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28310 ROADSIDE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4958
Mailing Address - Country:US
Mailing Address - Phone:714-865-2164
Mailing Address - Fax:805-342-2130
Practice Address - Street 1:28310 ROADSIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4958
Practice Address - Country:US
Practice Address - Phone:714-865-2164
Practice Address - Fax:805-342-2130
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21711103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical