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General NPI Number Information
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NPI Number | 1558750273
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Entity Type | Individual
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Provider Name | SMITH EDDIE KIDKARNDEE PSY.D., HSP
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Gender | Male
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 41C NEW LONDON TPKE
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City | GLASTONBURY
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State | CT
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Zip | 06033-4206
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Country | US
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Telephone | 860-288-7041
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Fax |
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Provider Business Mailing Address
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Address Line | 181 NORTH ST
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City | HEBRON
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State | CT
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Zip | 06248-1125
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Country | US
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Telephone | 917-445-6423
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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 | 3542
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License Number State | CT
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