Provider Demographics
NPI:1710200597
Name:SMITH, LINDA S (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2507 POST RD FL 3
Mailing Address - Street 2:
Mailing Address - City:SOUTHPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06890-1259
Mailing Address - Country:US
Mailing Address - Phone:203-255-0325
Mailing Address - Fax:203-721-6103
Practice Address - Street 1:2507 POST RD FL 3
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890-1259
Practice Address - Country:US
Practice Address - Phone:203-255-0325
Practice Address - Fax:203-721-6103
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CT002977103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist