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General NPI Number Information
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NPI Number | 1508061169
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Entity Type | Individual
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Provider Name | PETER NORMAN SMITH PSYD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 101 LIVINGSTON LOOP STE 1
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City | SANTA TERESA
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State | NM
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Zip | 88008-9753
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Country | US
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Telephone | 505-506-2546
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Fax | 575-201-7070
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Provider Business Mailing Address
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Address Line | 60 BEACH ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-1607
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Country | US
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Telephone | 505-506-2546
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Fax | 575-201-7070
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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 | 1290
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | 0039C
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number | PSY-RXP0053
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License Number State | NM
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