Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4323 | NC |
N | 103T00000X | Psychologist | 4323 | NC |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 05244 | MD |
NPI | 1043536709 |
---|---|
Provider Name | Dr. Kiu Amani Eubanks Smith |
First Address | Baltimore, MD 21212 |
Second Address | Owings Mills, MD 21117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2010 |
Last Update Date | 19/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
058535100 | (05) | MD |