Provider Demographics
NPI:1174029177
Name:ANN EMILIE-CLARE SMITH PSYD LP P.C.
Entity type:Organization
Organization Name:ANN EMILIE-CLARE SMITH PSYD LP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:EMILIE-CLARE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:248-535-2647
Mailing Address - Street 1:2209 SUNNYKNOLL AVE
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1791
Mailing Address - Country:US
Mailing Address - Phone:248-535-2647
Mailing Address - Fax:
Practice Address - Street 1:195 W 9 MILE RD STE 103
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1749
Practice Address - Country:US
Practice Address - Phone:248-535-2647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013774103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1194943209OtherNPI
11819364OtherCAQH
MI6301013774OtherSTATE OF MICHIGAN BOARD OF PSYCHOLOGY