Provider Demographics
NPI:1982792677
Name:SMITH, DALE EDWARD (MA)
Entity Type:Individual
Prefix:MR
First Name:DALE
Middle Name:EDWARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:DALE
Other - Middle Name:EDWARD
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:704 DEEP RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5292
Mailing Address - Country:US
Mailing Address - Phone:410-642-2411
Mailing Address - Fax:410-642-1852
Practice Address - Street 1:VA MEDICAL CENTER, PERRY POINT
Practice Address - Street 2:1H CIRCLE DRIVE BUILDING
Practice Address - City:PERRY POINT
Practice Address - State:MD
Practice Address - Zip Code:21902
Practice Address - Country:US
Practice Address - Phone:410-642-2411
Practice Address - Fax:410-642-1852
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC0111101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional