Provider Demographics
NPI:1497766752
Name:SMITH, TIMOTHY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 SE 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-7346
Mailing Address - Country:US
Mailing Address - Phone:352-548-1800
Mailing Address - Fax:352-548-1850
Practice Address - Street 1:1604 SE 3RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-7346
Practice Address - Country:US
Practice Address - Phone:352-548-1800
Practice Address - Fax:352-548-1850
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005436-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical