Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS018943 | PA |
Y | 103TC0700X | Clinical Psychologist | PS018943 | PA |
NPI | 1003453952 |
---|---|
Provider Name | Dr. Bridget Smith |
First Address | Philadelphia, PA 19146-1133 |
Second Address | Philadelphia, PA 19146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2019 |
Last Update Date | 10/12/2019 |