Provider Demographics
NPI:1548328412
Name:SMITH, ROSELYN G (PHD)
Entity type:Individual
Prefix:DR
First Name:ROSELYN
Middle Name:G
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 1:7685 SW 104TH ST.
Mailing Address - Street 2:STE. 100
Mailing Address - City:MIAMI/PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3161
Mailing Address - Country:US
Mailing Address - Phone:305-666-8000
Mailing Address - Fax:305-666-4311
Practice Address - Street 1:7685 SW 104TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3161
Practice Address - Country:US
Practice Address - Phone:305-804-5418
Practice Address - Fax:305-662-4731
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical