Provider Demographics
NPI:1811021652
Name:SMITH, ALEXANDER
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1849 PANTON RD
Mailing Address - Street 2:
Mailing Address - City:PANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05491-9481
Mailing Address - Country:US
Mailing Address - Phone:802-475-5216
Mailing Address - Fax:
Practice Address - Street 1:1849 PANTON RD
Practice Address - Street 2:
Practice Address - City:PANTON
Practice Address - State:VT
Practice Address - Zip Code:05491-9481
Practice Address - Country:US
Practice Address - Phone:802-475-5216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047-0000613103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist