Individual
KEVIN J SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
5001 MAYFIELD RD, SUITE 200, LYNDHURST, OH 44124-2602
(216) 291-4000
(216) 291-4111
Mailing address
5001 MAYFIELD RD, SUITE 200, LYNDHURST, OH 44124-2602
(216) 291-4000
(216) 291-4111
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4780
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000190318
ANTHEM
OH
05
—
0964256
—
OH
01
—
6100371
EVERCARE
OH
Enumeration date
10/04/2006
Last updated
07/08/2007
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