MEDICARE: ALYSSA SMYTH PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	61660454	WA

General Provider Information

NPI Number	:	1033754684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA SMYTH PHD

Provider Business Mailing Address
First Line	:	9240 JENSEN WAY NE
Second Line	:	#1719
City	:	POULSBO
State	:	WA
Zip	:	98370
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 ERICKSEN AVE NE STE 100
Second Line	:
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2835
Country	:	US
Telephone Number	:	253-260-5597
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2019
Last Update Date	:	12/24/2025

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