MEDICARE: DR. MICHELLE SUN SMITH PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	3799	MD

General Provider Information

NPI Number	:	1518029396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHELLE SUN SMITH PH.D.

Provider Business Mailing Address
First Line	:	828 DULANEY VALLEY RD
Second Line	:	SUITE 9
City	:	TOWSON
State	:	MD
Zip	:	21204-2822
Country	:	US
Telephone Number	:	410-823-1880
Fax Number	:	410-823-1889

Provider Business Practice Location Address
First Line	:	828 DULANEY VALLEY RD
Second Line	:	SUITE 9
City	:	TOWSON
State	:	MD
Zip	:	21204-2822
Country	:	US
Telephone Number	:	410-823-1880
Fax Number	:	410-823-1889

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/08/2007

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