MEDICARE: ROSALYN S 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	005782 1	NY

General Provider Information

NPI Number	:	1982820296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALYN S SMITH PH.D.

Provider Business Mailing Address
First Line	:	120 HILLSIDE AVE
Second Line	:	C1
City	:	WATERBURY
State	:	CT
Zip	:	06710-2139
Country	:	US
Telephone Number	:	203-755-0455
Fax Number	:	203-755-0455

Provider Business Practice Location Address
First Line	:	333 PARK AVE S
Second Line	:	3D
City	:	NEW YORK
State	:	NY
Zip	:	10010-2906
Country	:	US
Telephone Number	:	212-388-1903
Fax Number	:	212-388-0767

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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