Individual
MARTIN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
777 9TH ST N, NAPLES, FL 34102-8135
(502) 387-2336
Mailing address
11120 S CROWN WAY STE 1, WELLINGTON, FL 33414-8718
(502) 387-2336
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
KY-1144
KY
103TC0700X
Clinical Psychologist
Primary
PY10065
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
184607
MEDICARE GROUP NUMBER
KY
Enumeration date
06/28/2006
Last updated
02/20/2019
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