Healthcare Provider Details

I. General information

NPI: 1851354351
Provider Name (Legal Business Name): LARRY DEAN SMYTH PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7827 WISE AVE
DUNDALK MD
21222-3339
US

IV. Provider business mailing address

7827 WISE AVE
DUNDALK MD
21222-3339
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-7222
  • Fax: 410-282-0069
Mailing address:
  • Phone: 410-642-2411
  • Fax: 410-642-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number02753
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: