MEDICARE: JAMIE ARLENE MARIE SMITH

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	103TC2200X	Clinical Child & Adolescent Psychologist
2	103TC0700X	Clinical Psychologist	6361003441	MI

General Provider Information

NPI Number	:	1235840075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE ARLENE MARIE SMITH

Provider Business Mailing Address
First Line	:	441 S LIVERNOIS RD STE 100
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2585
Country	:	US
Telephone Number	:	586-202-3863
Fax Number	:

Provider Business Practice Location Address
First Line	:	441 S LIVERNOIS RD STE 100
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-2585
Country	:	US
Telephone Number	:	248-608-8800
Fax Number	:

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

Provider Enumeration Date	:	12/13/2022
Last Update Date	:	12/01/2025

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Directions to “ JAMIE ARLENE MARIE SMITH ” Practice Location

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