Provider Demographics
NPI:1689926677
Name:SMITH, DANIEL V (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:V
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 CENTER STREET NE (OFFICE GO5-216)
Mailing Address - Street 2:OREGON STATE HOSPITAL, FORENSIC EVALUATION SERVICE
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2669
Mailing Address - Country:US
Mailing Address - Phone:503-945-9281
Mailing Address - Fax:503-945-9747
Practice Address - Street 1:2600 CENTER STREET NE (OFFICE GO5-216)
Practice Address - Street 2:OREGON STATE HOSPITAL, FORENSIC EVALUATION SERVICE
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2669
Practice Address - Country:US
Practice Address - Phone:503-945-9281
Practice Address - Fax:503-945-9747
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1913103TF0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical