Provider Demographics
NPI:1487775185
Name:SMITH, LAURIE ANN (LCSW)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JOSE FIGUERES AVE
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-2068
Mailing Address - Country:US
Mailing Address - Phone:408-347-3128
Mailing Address - Fax:408-347-3135
Practice Address - Street 1:101 JOSE FIGUERES AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-2068
Practice Address - Country:US
Practice Address - Phone:408-347-3128
Practice Address - Fax:408-347-3135
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical