Provider Demographics
NPI:1265670202
Name:EVANS-SMITH, BERNADETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:
Last Name:EVANS-SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11000 PROSPERITY FARMS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-3470
Mailing Address - Country:US
Mailing Address - Phone:561-558-4161
Mailing Address - Fax:
Practice Address - Street 1:11000 PROSPERITY FARMS RD STE 200
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-3470
Practice Address - Country:US
Practice Address - Phone:561-558-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15988103TC0700X
IL071007549103TC0700X
FL9262103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical