Provider Demographics
NPI:1306846597
Name:SMITH, JAMES B (LICENSEDPSYCHOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:B
Last Name:SMITH
Suffix:
Gender:M
Credentials:LICENSEDPSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:5501 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1529
Mailing Address - Country:US
Mailing Address - Phone:304-723-3423
Mailing Address - Fax:304-723-3426
Practice Address - Street 1:2436 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3641
Practice Address - Country:US
Practice Address - Phone:304-723-3423
Practice Address - Fax:304-723-3426
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV622103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0023528001Medicaid
WV550583609043OtherBLUE CROSS/BLUE SHIELD
WVY034223OtherHEALTH PLAN
WVSM0814141Medicare ID - Type Unspecified