Healthcare Provider Details

I. General information

NPI: 1235223116
Provider Name (Legal Business Name): KEVIN FRANCIS SMYTHE PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 LAKE BOONE TRL STE 300
RALEIGH NC
27607-2969
US

IV. Provider business mailing address

100 BRIARBERRY CT
APEX NC
27502-8089
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-9182
  • Fax: 919-784-9184
Mailing address:
  • Phone: 919-303-9984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: