Provider Demographics
NPI:1669596276
Name:SMITH, JAMES JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2914 E JOPPA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-3031
Mailing Address - Country:US
Mailing Address - Phone:410-321-6655
Mailing Address - Fax:
Practice Address - Street 1:2914 E JOPPA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-3031
Practice Address - Country:US
Practice Address - Phone:410-321-6655
Practice Address - Fax:410-529-1799
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02241103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02241OtherPSYCHOLOGY LICENSE