Provider Demographics
NPI:1295818326
Name:SMITH, DAVID M (PSYD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11181 HEALTH PARK BLVD
Mailing Address - Street 2:#3050
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-5744
Mailing Address - Country:US
Mailing Address - Phone:239-592-7535
Mailing Address - Fax:239-592-5987
Practice Address - Street 1:11181 HEALTH PARK BLVD
Practice Address - Street 2:#3050
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-5744
Practice Address - Country:US
Practice Address - Phone:239-592-7535
Practice Address - Fax:239-592-5987
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6413103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
54706Medicare UPIN