Provider Demographics
NPI:1497877070
Name:SMITH, VINCENT G (PHD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:G
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 1:12 PARMENTER RD UNIT A3
Mailing Address - Street 2:
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3200
Mailing Address - Country:US
Mailing Address - Phone:603-434-2013
Mailing Address - Fax:603-434-2013
Practice Address - Street 1:12 PARMENTER RD UNIT A3
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3200
Practice Address - Country:US
Practice Address - Phone:603-434-2013
Practice Address - Fax:603-434-2013
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH194103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical