| Doctor Name: | SAMUEL BARDWELL SMITH |
| NPI Number: | 1285805846 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | PSY 20860 |
| Business Practice Address: | 1279 Linda Mar Shopping Ctr Suite 112 Pacifica, CA - 940443347 |
| Business Phone Number: | 6502284981 |
| Business Fax Number: | |
| Mailing Address: | 1279 Linda Mar Shopping Ctr, Suite 112 PACIFICA |
| State: | CA |
| Postal Code: | 940443347 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/21/2008 |
| NPI Last Update Date: | 03/21/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY 20860 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |