Healthcare Provider Details

I. General information

NPI: 1821130683
Provider Name (Legal Business Name): DEBORAH JEAN SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 BALLARD ST
ALTAMONTE SPRINGS FL
32701-5441
US

IV. Provider business mailing address

7901 LAKE WAUNATTA DR
WINTER PARK FL
32792-8937
US

V. Phone/Fax

Practice location:
  • Phone: 407-331-1903
  • Fax:
Mailing address:
  • Phone: 407-619-1374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY5675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: