Healthcare Provider Details

I. General information

NPI: 1073649232
Provider Name (Legal Business Name): ROSELYN G SMITH PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 07/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7685 SW 104TH ST SUITE 100
MIAMI FL
33156-3161
US

IV. Provider business mailing address

7685 SW 104TH ST SUITE 100
MIAMI FL
33156-3161
US

V. Phone/Fax

Practice location:
  • Phone: 305-804-5418
  • Fax: 305-662-4731
Mailing address:
  • Phone: 305-804-5418
  • Fax: 305-662-4731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberPY7219
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY7219
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberPY7219
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY7219
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPY7219
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License NumberPY7219
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License NumberPY7219
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License NumberPY7219
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY7219
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPY7219
License Number StateFL
# 11
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY7219
License Number StateFL

VIII. Authorized Official

Name: DR. ROSELYN G SMITH
Title or Position: MGRM
Credential:
Phone: 305-804-5418