Doctor Name: | KEVIN J SMITH |
NPI Number: | 1124113261 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 4780 |
Business Practice Address: | 5001 Mayfield Rd Suite 200 Lyndhurst, OH - 441242602 |
Business Phone Number: | 2162914000 |
Business Fax Number: | 2162914111 |
Mailing Address: | 5001 Mayfield Rd, Suite 200 LYNDHURST |
State: | OH |
Postal Code: | 441242602 |
Phone Number: | 2162914000 |
Fax Number: | 2162914111 |
NPI Enumeration Date: | 10/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 4780 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |