Provider Demographics
NPI:1982820296
Name:SMITH, ROSALYN S (PHD)
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
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Mailing Address - Street 1:120 HILLSIDE AVE
Mailing Address - Street 2:C1
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-2139
Mailing Address - Country:US
Mailing Address - Phone:203-755-0455
Mailing Address - Fax:203-755-0455
Practice Address - Street 1:333 PARK AVE S
Practice Address - Street 2:3D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2906
Practice Address - Country:US
Practice Address - Phone:212-388-1903
Practice Address - Fax:212-388-0767
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY005782 1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVL5421Medicare ID - Type UnspecifiedPSYCHOLOGIST