Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3207 | OH |
Y | 103T00000X | Psychologist | 3207 | OH |
N | 103TA0700X | Adult Development & Aging Psychologist | 3207 | OH |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 3207 | OH |
N | 103G00000X | Clinical Psychologist | 3207 | OH |
N | 103TC0700X | Clinical Psychologist | 3207 | OH |
N | 103TC1900X | Counseling Psychologist | 3207 | OH |
N | 103TF0000X | Family Psychologist | 3207 | OH |
N | 103TH0004X | Health Psychologist | 3207 | OH |
NPI | 1275588998 |
---|---|
Provider Name | Carole P Smith |
First Address | Stow, OH 44224-1411 |
Second Address | Stow, OH 44224-1411 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 08/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R71622 | (02) |