Provider Demographics
NPI:1992256200
Name:SMITH, REBECCA ANNE ELLIOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:ANNE ELLIOTT
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 1:921 HIDALGO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-2721
Mailing Address - Country:US
Mailing Address - Phone:504-434-2850
Mailing Address - Fax:
Practice Address - Street 1:4650 GENERAL DE GAULLE DR STE 213
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-7172
Practice Address - Country:US
Practice Address - Phone:504-434-2850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1381103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical