Provider Demographics
NPI:1003944935
Name:SMITH, LIZETTE JANINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LIZETTE
Middle Name:JANINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LIZETTE
Other - Middle Name:JANINE
Other - Last Name:SMITH-BONNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1182 DUNSTON DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5644
Mailing Address - Country:US
Mailing Address - Phone:314-432-2308
Mailing Address - Fax:
Practice Address - Street 1:4316 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2702
Practice Address - Country:US
Practice Address - Phone:314-533-2229
Practice Address - Fax:314-533-7496
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01487103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical