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Individual
JACQUELYN E SMITH
Active
Individual
JACQUELYN E SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
80809
CA
1041C0700X
Clinical Social Worker
904014405
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95-2633765
—
CA
Enumeration date
11/25/2013
Last updated
05/22/2023
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