Provider Demographics
NPI:1245240084
Name:SMART, PATRICIA W (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:W
Last Name:SMART
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 1:3328 RAVINE PL
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8714
Mailing Address - Country:US
Mailing Address - Phone:513-492-7505
Mailing Address - Fax:
Practice Address - Street 1:8587 S MASON MONTGOMERY RD
Practice Address - Street 2:STE 9
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9233
Practice Address - Country:US
Practice Address - Phone:513-492-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6892103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH82528PMedicare PIN