Provider Demographics
NPI:1386805372
Name:SMITH, VANESSA
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4402
Mailing Address - Country:US
Mailing Address - Phone:831-427-9343
Mailing Address - Fax:831-427-9345
Practice Address - Street 1:300 HARVEY WEST BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2103
Practice Address - Country:US
Practice Address - Phone:831-425-8132
Practice Address - Fax:831-425-4581
Is Sole Proprietor?:No
Enumeration Date:2008-06-23
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA738541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health