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NPI Code Detail

MEDICARE: DR. JUDSON D. SMITH ED.D.

MEDICARE: DR. JUDSON D. SMITH ED.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
1103TC0700XClinical PsychologistPS352ME
2103T00000XPsychologistPS352ME

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1098303OTHERMEANTHEM LEGACY NUMBER

General Provider Information

NPI Number : 1518937242
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JUDSON D. SMITH ED.D.
Provider Business Mailing Address
First Line : 29 FRANKLIN ST
Second Line :
City : BANGOR
State : ME
Zip : 04401-4909
Country : US
Telephone Number : 207-942-3816
Fax Number : 207-561-4725
Provider Business Practice Location Address
First Line : 62 ELM ST
Second Line :
City : PORTLAND
State : ME
Zip : 04101-3091
Country : US
Telephone Number : 207-553-7056
Fax Number : 207-773-2082
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2006
Last Update Date : 10/03/2007

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