Provider Demographics
NPI:1316235195
Name:SMITH, DENISE GABRIELA
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:GABRIELA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DENISE
Other - Middle Name:GABRIELA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2633 E 27TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1912
Mailing Address - Country:US
Mailing Address - Phone:510-536-8111
Mailing Address - Fax:510-534-5202
Practice Address - Street 1:2633 E 27TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1912
Practice Address - Country:US
Practice Address - Phone:510-536-8111
Practice Address - Fax:510-434-5202
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112128106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist