Provider Demographics
NPI:1619852522
Name:SMITH, WILBERT (CLINICAL PSYCH)
Entity type:Individual
Prefix:DR
First Name:WILBERT
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1776
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-0776
Mailing Address - Country:US
Mailing Address - Phone:310-299-5910
Mailing Address - Fax:310-504-2249
Practice Address - Street 1:877 N DOUGLAS ST., PACIFIC PSYCHOLOGICAL ASS.
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90242
Practice Address - Country:US
Practice Address - Phone:310-299-5910
Practice Address - Fax:310-504-2249
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94028313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical