Provider Demographics
NPI:1194981902
Name:SMITH, JAMIE LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1714 BOARDMAN POLAND RD STE 9
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-1957
Mailing Address - Country:US
Mailing Address - Phone:330-861-3930
Mailing Address - Fax:
Practice Address - Street 1:1714 BOARDMAN POLAND RD STE 9
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44514-1957
Practice Address - Country:US
Practice Address - Phone:330-861-3930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-31
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
OH6750103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional