Provider Demographics
NPI:1194886176
Name:SMITH, LYNDA B (PHD)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 CHANNING STREET
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5735
Mailing Address - Country:US
Mailing Address - Phone:860-389-2668
Mailing Address - Fax:860-437-2153
Practice Address - Street 1:24 CHANNING STREET
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5735
Practice Address - Country:US
Practice Address - Phone:860-389-2668
Practice Address - Fax:860-437-2153
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001978103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist