Provider Demographics
NPI:1386711950
Name:SMITH, DAVID PAUL (MA, PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:SMITH
Suffix:
Gender:
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2334 W LAWRENCE AVE STE 212
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1037
Mailing Address - Country:US
Mailing Address - Phone:773-562-3276
Mailing Address - Fax:773-363-0600
Practice Address - Street 1:2334 W LAWRENCE AVE STE 212
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1037
Practice Address - Country:US
Practice Address - Phone:773-562-3276
Practice Address - Fax:773-363-0600
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-006030103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1635194OtherBCBS
IL211788Medicare ID - Type UnspecifiedPSYCHOLOGIST