Provider Demographics
NPI:1114316825
Name:DEBORAH S SMITH PSYD LLC
Entity Type:Organization
Organization Name:DEBORAH S SMITH PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-652-4040
Mailing Address - Street 1:310 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4461
Mailing Address - Country:US
Mailing Address - Phone:609-652-4040
Mailing Address - Fax:609-652-5340
Practice Address - Street 1:310 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4461
Practice Address - Country:US
Practice Address - Phone:609-652-4040
Practice Address - Fax:609-652-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100389500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ213762Medicare UPIN