Provider Demographics
NPI:1558750273
Name:KIDKARNDEE, SMITH EDDIE (PSYD, HSP)
Entity Type:Individual
Prefix:DR
First Name:SMITH
Middle Name:EDDIE
Last Name:KIDKARNDEE
Suffix:
Gender:M
Credentials:PSYD, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1125
Mailing Address - Country:US
Mailing Address - Phone:917-445-6423
Mailing Address - Fax:
Practice Address - Street 1:41C NEW LONDON TPKE
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4206
Practice Address - Country:US
Practice Address - Phone:860-288-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3542103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty