Provider Demographics
NPI:1578372637
Name:SMITH, ELIZABETH JANE (MA)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JANE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 STONY POINT RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4186
Mailing Address - Country:US
Mailing Address - Phone:387-070-7890
Mailing Address - Fax:
Practice Address - Street 1:4650 BADGER RD
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-2633
Practice Address - Country:US
Practice Address - Phone:387-070-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist