Healthcare Provider Details

I. General information

NPI: 1003032343
Provider Name (Legal Business Name): CARA LEANN SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 SOUTH OLIVE AVE.
WEST PALM BEACH FL
33401-6725
US

IV. Provider business mailing address

8155 CHELSEA CT APT A
LAKE CLARKE SHORES FL
33406-8414
US

V. Phone/Fax

Practice location:
  • Phone: 561-641-3086
  • Fax: 561-641-3086
Mailing address:
  • Phone: 561-641-3086
  • Fax: 561-641-3086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 7361
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: