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General NPI Number Information
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NPI Number | 1780464370
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Entity Type | Individual
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Provider Name | JOSHUA SMITH PSYD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/02/2023
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Provider Practice Location Address
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Address Line | 7301 N SHADELAND AVE # CLINIC1A
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2085
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Country | US
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Telephone | 317-348-3622
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Fax |
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Provider Business Mailing Address
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Address Line | 5432 GEARY BLVD
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City | SAN FRANCISCO
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State | CA
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Zip | 94121-2307
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Country | US
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Telephone |
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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 | 200427771A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 130402
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License Number State | KY
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