Provider Demographics
NPI:1508884032
Name:SMITH, DEBRA L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
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 1:112 W WASHINGTON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855
Mailing Address - Country:US
Mailing Address - Phone:906-225-1776
Mailing Address - Fax:906-225-1781
Practice Address - Street 1:112 W WASHINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855
Practice Address - Country:US
Practice Address - Phone:906-225-1776
Practice Address - Fax:906-225-1781
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI680E210310OtherBCBS
ON96180Medicare ID - Type Unspecified