Provider Demographics
NPI:1326062340
Name:SMITH, ROSEMARY L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:L
Last Name:SMITH
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 1:1215 QUARRIER STREET
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1839
Mailing Address - Country:US
Mailing Address - Phone:304-344-0349
Mailing Address - Fax:304-344-0384
Practice Address - Street 1:1215 QUARRIER ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1809
Practice Address - Country:US
Practice Address - Phone:304-344-0349
Practice Address - Fax:304-344-0384
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV457103TC0700X
OH4962103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0163119000Medicaid
WV0163119000Medicaid