Provider Demographics
NPI:1316748742
Name:KIP SMITH, PHD REHABILITATION PSYCHOLOGY LLC
Entity type:Organization
Organization Name:KIP SMITH, PHD REHABILITATION PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:216-407-3470
Mailing Address - Street 1:3601 GREEN RD STE 218
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5719
Mailing Address - Country:US
Mailing Address - Phone:216-407-3470
Mailing Address - Fax:216-595-0088
Practice Address - Street 1:3601 GREEN RD STE 218
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5719
Practice Address - Country:US
Practice Address - Phone:216-407-3470
Practice Address - Fax:216-595-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty