Healthcare Provider Details

I. General information

NPI: 1376456509
Provider Name (Legal Business Name): MARY SMIRNOVA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 MOUNT ROSE ST
RENO NV
89509-3355
US

IV. Provider business mailing address

2300 DICKERSON RD APT 42
RENO NV
89503-4930
US

V. Phone/Fax

Practice location:
  • Phone: 775-448-6828
  • Fax:
Mailing address:
  • Phone: 775-488-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY1347
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: