Provider Demographics
NPI:1255425344
Name:SMITH, DEBORAH S (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:S
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 1:310 CHRIS GAUPP DR
Mailing Address - Street 2:SUITE 105 GALLOWAY MENTAL HEALTH
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4461
Mailing Address - Country:US
Mailing Address - Phone:609-652-4040
Mailing Address - Fax:609-652-3908
Practice Address - Street 1:310 CHRIS GAUPP DR
Practice Address - Street 2:GALLOWAY MENTAL HEALTH, SUITE 105
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4461
Practice Address - Country:US
Practice Address - Phone:609-652-4040
Practice Address - Fax:609-652-3908
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100389500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0074373Medicaid
NJ089159Medicare ID - Type Unspecified