Provider Demographics
NPI:1952339020
Name:WARD, SMITA D (PHD, HSPP)
Entity Type:Individual
Prefix:
First Name:SMITA
Middle Name:D
Last Name:WARD
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 WALLHAVEN DR
Mailing Address - Street 2:APT C
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-3941
Mailing Address - Country:US
Mailing Address - Phone:765-446-9394
Mailing Address - Fax:765-447-8875
Practice Address - Street 1:3660 ROME DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4488
Practice Address - Country:US
Practice Address - Phone:765-446-9394
Practice Address - Fax:765-447-8875
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041163A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN225210NMedicare UPIN
IN070930MMedicare ID - Type Unspecified