Provider Demographics
NPI:1134741473
Name:SMITH, CIARA (DNP, PMHNP)
Entity type:Individual
Prefix:DR
First Name:CIARA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DNP, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 WASHINGTONIAN BLVD STE 550
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-5789
Mailing Address - Country:US
Mailing Address - Phone:240-255-9804
Mailing Address - Fax:240-348-8923
Practice Address - Street 1:9711 WASHINGTONIAN BLVD STE 550
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-5789
Practice Address - Country:US
Practice Address - Phone:240-255-9804
Practice Address - Fax:240-348-8923
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-09
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201036363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health