Provider Demographics
NPI:1366727190
Name:SMITH, DOUGLAS A (PSYD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42B WRIGHT ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:MA
Mailing Address - Zip Code:01069-1156
Mailing Address - Country:US
Mailing Address - Phone:413-284-5285
Mailing Address - Fax:413-284-5384
Practice Address - Street 1:42B WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1156
Practice Address - Country:US
Practice Address - Phone:413-284-5285
Practice Address - Fax:413-284-5384
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist