Individual
DR. MAURICE BRADLEY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.,L.P.
Contact information
Practice address
1935 COUNTY ROAD B2 W STE 270, ROSEVILLE, MN 55113-2785
(651) 481-0664
(651) 846-5877
Mailing address
1935 COUNTY ROAD B2 W STE 270, ROSEVILLE, MN 55113-2785
(651) 481-0664
(651) 846-5877
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP0783
MN
103TM1800X
Intellectual & Developmental Disabilities Psychologist
LP0783
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092353200
—
MN
01
—
27F90SM
BLUE CROSS/BLUE SHIELD
MN
01
—
6150656
MEDICA/UNITED BEH. HEALTH
MN
01
—
680016304
RAIL ROAD MEDICARE
MN
01
—
HP21325
HEALTH PARTNERS INSURANCE
MN
Enumeration date
10/04/2006
Last updated
02/06/2019
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