MEDICARE: CHARITY ANN 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	103TC0700X	Clinical Psychologist	20043399A	IN

General Provider Information

NPI Number	:	1396226130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY ANN SMITH

Provider Business Mailing Address
First Line	:	7230 ENGLE RD STE 304
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2227
Country	:	US
Telephone Number	:	260-483-2400
Fax Number	:

Provider Business Practice Location Address
First Line	:	7230 ENGLE RD STE 304
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-2227
Country	:	US
Telephone Number	:	260-483-2400
Fax Number	:	260-960-9361

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

Provider Enumeration Date	:	08/28/2018
Last Update Date	:	03/10/2021

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Directions to “ CHARITY ANN SMITH ” Practice Location

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