Provider Demographics
NPI:1811319239
Name:SMOTHERS, DAMON B (SSPSY, MED, LEP)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:B
Last Name:SMOTHERS
Suffix:
Gender:M
Credentials:SSPSY, MED, LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROSEDOWN CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3313
Mailing Address - Country:US
Mailing Address - Phone:504-352-1841
Mailing Address - Fax:
Practice Address - Street 1:1 ROSEDOWN CT
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-3313
Practice Address - Country:US
Practice Address - Phone:043-521-8415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CALEP2679103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool