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General NPI Number Information
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NPI Number | 1295848091
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Entity Type | Individual
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Provider Name | TIMOTHY DAVID LE JACQ-SMITH PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 02/05/2026
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Provider Practice Location Address
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Address Line | 501 ANGELL ST
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City | PROVIDENCE
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State | RI
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Zip | 02906-4467
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Country | US
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Telephone | 401-243-4199
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Fax |
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Provider Business Mailing Address
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Address Line | 8 AIMES WAY
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City | WESTPORT
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State | MA
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Zip | 02790-1260
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Country | US
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Telephone | 401-243-4199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8125
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS00764
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License Number State | RI
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