Provider Demographics
NPI:1477518876
Name:SMOTHERS, ROGER (MS)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:SMOTHERS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27241 STATE ROUTE 267
Mailing Address - Street 2:
Mailing Address - City:FRIENDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18818-8640
Mailing Address - Country:US
Mailing Address - Phone:570-553-2078
Mailing Address - Fax:607-772-2041
Practice Address - Street 1:27241 STATE ROUTE 267
Practice Address - Street 2:
Practice Address - City:FRIENDSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18818-8640
Practice Address - Country:US
Practice Address - Phone:570-553-2078
Practice Address - Fax:607-772-2041
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004970L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA615053OtherHIGHMARK BC/BS
PA080439OtherFIRST PRIORITY HEALTH