Provider Demographics
NPI:1811467400
Name:SMITH, CARA VICTORIA
Entity type:Individual
Prefix:MRS
First Name:CARA
Middle Name:VICTORIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22313 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-4137
Mailing Address - Country:US
Mailing Address - Phone:301-475-2696
Mailing Address - Fax:
Practice Address - Street 1:PINEY POINT ELEMENTARY SCHOOL 44550 TALL TIMBERS ROAD
Practice Address - Street 2:
Practice Address - City:TALL TIMBERS
Practice Address - State:MD
Practice Address - Zip Code:20690-2009
Practice Address - Country:US
Practice Address - Phone:301-994-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03842235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist