Healthcare Provider Details

I. General information

NPI: 1063912921
Provider Name (Legal Business Name): DEONDRA SMITH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DEONDRA JACOBS

II. Dates (important events)

Enumeration Date: 02/17/2018
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 RITCHIE HWY STE 12F
SEVERNA PARK MD
21146-4133
US

IV. Provider business mailing address

836 RITCHIE HWY STE 12F
SEVERNA PARK MD
21146-4133
US

V. Phone/Fax

Practice location:
  • Phone: 410-670-9048
  • Fax: 410-835-9612
Mailing address:
  • Phone: 410-670-9048
  • Fax: 410-835-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number05785
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: