Healthcare Provider Details

I. General information

NPI: 1871954420
Provider Name (Legal Business Name): MAUREEN CARROLL SMITH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2016
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3222 CHESTNUT HILL SCHOOL RD
DANDRIDGE TN
37725-7238
US

IV. Provider business mailing address

PO BOX 577
NEWPORT TN
37822-0577
US

V. Phone/Fax

Practice location:
  • Phone: 865-509-6611
  • Fax: 865-509-8811
Mailing address:
  • Phone: 423-613-3300
  • Fax: 423-623-4088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3367
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: