Provider Demographics
NPI:1548437619
Name:SMITH, CAROLINE PROUTY (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PROUTY
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 1:3626 SACRAMENTO ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1720
Mailing Address - Country:US
Mailing Address - Phone:415-869-7357
Mailing Address - Fax:
Practice Address - Street 1:3626 SACRAMENTO ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1720
Practice Address - Country:US
Practice Address - Phone:415-869-7357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical