Provider Demographics
NPI:1861541559
Name:SMITHLEY, BRIAN S (MED)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:S
Last Name:SMITHLEY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HAZEL LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1253
Mailing Address - Country:US
Mailing Address - Phone:412-749-7466
Mailing Address - Fax:412-749-7339
Practice Address - Street 1:111 HAZEL LANE
Practice Address - Street 2:SUITE 300
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143
Practice Address - Country:US
Practice Address - Phone:412-749-7466
Practice Address - Fax:412-749-7339
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-007796-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist