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NPI Code Detail

MEDICARE: CAROLYN SMITH PHD

MEDICARE: CAROLYN SMITH 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
1103TC0700XClinical Psychologist0810003008VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2137618OTHERVABCROSS

General Provider Information

NPI Number : 1609880202
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN SMITH PHD
Provider Business Mailing Address
First Line : PO BOX 382
Second Line :
City : ORANGE
State : VA
Zip : 22960-0220
Country : US
Telephone Number : 540-672-3388
Fax Number : 540-672-2709
Provider Business Practice Location Address
First Line : 13180 JAMES MADISON HWY
Second Line :
City : ORANGE
State : VA
Zip : 22960-2808
Country : US
Telephone Number : 540-672-3388
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2006
Last Update Date : 11/04/2018

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