Active NPI
Richard M Smith, PHD
- Clinical Psychologist
- Plattsburgh, NY
National Provider Identifier
1063558609
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5148
- Practice address
- 202 Cornelia Street
Ste C
Plattsburgh, NY 12901 - Phone
- (518) 563-1911
- Fax
- (518) 563-6640
- NPI assigned
- Jan 30, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 5148 | NY | Primary |
Addresses
Primary practice location
202 Cornelia Street
Ste C
Plattsburgh, NY 12901
Mailing address
202 Cornelia Street
Ste C
Plattsburgh, NY 12901
Phone (518) 563-1911
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00649541 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 005148 | NY | MD | Mental Health Counselor |
| 5148 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1063558609",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 CORNELIA STREET",
"address_2": "STE C",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "12901",
"telephone_number": "518-563-1911",
"fax_number": "518-563-6640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 CORNELIA STREET",
"address_2": "STE C",
"city": "PLATTSBURGH",
"state": "NY",
"postal_code": "12901",
"telephone_number": "518-563-1911",
"fax_number": "518-563-6640"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "RICHARD",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "5148",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00649541",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Plattsburgh, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.