Provider Demographics
NPI:1205611514
Name:SMITH, MARICELA MICHELLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARICELA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 E SOUTHERN AVE STE 1026
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-6202
Mailing Address - Country:US
Mailing Address - Phone:208-320-4801
Mailing Address - Fax:
Practice Address - Street 1:5222 E BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2963
Practice Address - Country:US
Practice Address - Phone:480-647-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPSY-005639103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist