Provider Demographics
NPI:1568852952
Name:SMITH, MARY CLARE (PHD, ATR-BC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CLARE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, ATR-BC
Other - Prefix:
Other - First Name:MARY/CAROL
Other - Middle Name:ROBERT CLARE/ROBERTA
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 22ND ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-2706
Mailing Address - Country:US
Mailing Address - Phone:419-241-6191
Mailing Address - Fax:
Practice Address - Street 1:123 22ND ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43604-2706
Practice Address - Country:US
Practice Address - Phone:419-241-6191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005000103TC0700X
OH7217103TC1900X
98-119221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist