Provider Demographics
NPI:1942487483
Name:SMITH, DAVID A (PHD, ABPP, HSPP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD, ABPP, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2322
Mailing Address - Country:US
Mailing Address - Phone:574-283-1107
Mailing Address - Fax:574-283-1131
Practice Address - Street 1:1251 N EDDY ST STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1478
Practice Address - Country:US
Practice Address - Phone:574-307-9147
Practice Address - Fax:574-213-6884
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041287A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical