Healthcare Provider Details

I. General information

NPI: 1629345749
Provider Name (Legal Business Name): RICHARD B. SMITH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 CONNECTICUT AVE NW SUITE 500
WASHINGTON DC
20036-1111
US

IV. Provider business mailing address

1555 CONNECTICUT AVE NW SUITE 500
WASHINGTON DC
20036-1111
US

V. Phone/Fax

Practice location:
  • Phone: 202-234-6227
  • Fax: 202-234-7898
Mailing address:
  • Phone: 202-234-6227
  • Fax: 202-234-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY1917
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: