Healthcare Provider Details

I. General information

NPI: 1275467383
Provider Name (Legal Business Name): RAESHELLE SMITH BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 BALTIMORE ANNAPOLIS BLVD STE 202
SEVERNA PARK MD
21146-4716
US

IV. Provider business mailing address

852 LAKE SHORE DR
BOWIE MD
20721-2900
US

V. Phone/Fax

Practice location:
  • Phone: 410-684-3806
  • Fax:
Mailing address:
  • Phone: 909-461-7743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: