Provider Demographics
NPI:1295807105
Name:SMITH, MARYCATHERINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARYCATHERINE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARYKATE
Other - Middle Name:
Other - Last Name:SMITH-EBERLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:10655 S CRESCENT BEND DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5290
Mailing Address - Country:US
Mailing Address - Phone:845-216-9738
Mailing Address - Fax:801-996-3762
Practice Address - Street 1:11075 S STATE ST STE 16
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5196
Practice Address - Country:US
Practice Address - Phone:845-216-9738
Practice Address - Fax:801-996-3762
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1120103T00000X
NY015157-0103T00000X
UT9649381-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist