Provider Demographics
NPI:1871669713
Name:SMITH, DAVID THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Mailing Address - Street 2:3333 BURNET AVENUE
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3039
Mailing Address - Country:US
Mailing Address - Phone:513-636-8165
Mailing Address - Fax:513-636-7361
Practice Address - Street 1:CINCINNATI CHILDREN'S HOSPITAL MEDICAL CENTER
Practice Address - Street 2:3333 BURNET AVENUE
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-8165
Practice Address - Fax:513-636-7361
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH3029103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0160258Medicaid