Provider Demographics
NPI:1821345364
Name:SMITH, ANNE-LISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE-LISE
Middle Name:
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:P.O. BOX 60233
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062
Mailing Address - Country:US
Mailing Address - Phone:434-422-6114
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN STREET
Practice Address - Street 2:SUITE 217
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3172
Practice Address - Country:US
Practice Address - Phone:434-422-6114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3544103T00000X
VA0810005762103TC0700X
MA11786103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist