Provider Demographics
NPI:1225651425
Name:SMYTH, CHELSIE K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHELSIE
Middle Name:K
Last Name:SMYTH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E PRINCETON ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1435
Mailing Address - Country:US
Mailing Address - Phone:407-303-8877
Mailing Address - Fax:407-303-8811
Practice Address - Street 1:615 E PRINCETON ST STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1435
Practice Address - Country:US
Practice Address - Phone:407-303-8877
Practice Address - Fax:407-303-8811
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-21
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
FLPY11674103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist