Provider Demographics
NPI:1871954420
Name:SMITH, MAUREEN CARROLL (PSYD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:CARROLL
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37822-0577
Mailing Address - Country:US
Mailing Address - Phone:423-613-3300
Mailing Address - Fax:423-623-4088
Practice Address - Street 1:3222 CHESTNUT HILL SCHOOL RD
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725-7238
Practice Address - Country:US
Practice Address - Phone:865-509-6611
Practice Address - Fax:865-509-8811
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3367103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist