Provider Demographics
NPI:1578018180
Name:SMITH, FREDERICK ALEXANDER (PSYD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:ALEXANDER
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4545 42ND ST NW
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4623
Mailing Address - Country:US
Mailing Address - Phone:202-431-5267
Mailing Address - Fax:
Practice Address - Street 1:4545 42ND ST NW
Practice Address - Street 2:SUITE 204
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4623
Practice Address - Country:US
Practice Address - Phone:202-431-5267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical