Provider Demographics
NPI:1134255011
Name:SMITH, DUANE (BA)
Entity type:Individual
Prefix:MR
First Name:DUANE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 3RD ST STE 201
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-0554
Mailing Address - Country:US
Mailing Address - Phone:707-441-8626
Mailing Address - Fax:707-268-0218
Practice Address - Street 1:930 3RD ST STE 201
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-0554
Practice Address - Country:US
Practice Address - Phone:707-441-8626
Practice Address - Fax:707-442-5040
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW801391041C0700X
174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist