Provider Demographics
NPI:1619956877
Name:SMITH, KEVIN R (PHD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
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 1:6936 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1128
Mailing Address - Country:US
Mailing Address - Phone:412-687-6655
Mailing Address - Fax:
Practice Address - Street 1:552 N NEVILLE ST
Practice Address - Street 2:SUITE A
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-2855
Practice Address - Country:US
Practice Address - Phone:412-687-6655
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005435L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06165Medicare UPIN
PASM120846Medicare ID - Type UnspecifiedMEDICARE IDENTIFIER