Maurice Bradley Smith, PH.D.,L.P.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP0783 Issued in MN

Practice address

1935 County Road B2 W Ste 270
Roseville, MN 55113-2785

Phone

(651) 481-0664

Fax

(651) 846-5877

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Wayne State University School of Medicine, 1988

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bohn Counseling Associates, Inc,

  • Clinical Psychologist
  • Mahtomedi, MN
  • NPI 1881876050
  NPD (past)
• Cardenas and Reynolds Enterprises

  • Non-emergency Medical Transport (VAN)
  • Saint Paul, MN
  • NPI 1730358151
  NPD (past)
• Supportive Journeys Psychotherapy, LLC

  • Clinical Social Worker
  • Saint Paul, MN
  • NPI 1629404074
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549411200000",
    "number": "1467547257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1935 COUNTY ROAD B2 W STE 270",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132785",
            "telephone_number": "651-481-0664",
            "fax_number": "651-846-5877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1935 COUNTY ROAD B2 W STE 270",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551132785",
            "telephone_number": "651-481-0664",
            "fax_number": "651-846-5877"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "MAURICE",
        "middle_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "PH.D.,L.P.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2019-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP0783",
            "primary": true
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "MN",
            "license": "LP0783",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS INSURANCE",
            "identifier": "HP21325",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "27F90SM",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA/UNITED BEH. HEALTH",
            "identifier": "6150656",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "680016304",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092353200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brenda Linette Smieja
• Andrea Jolene Smith, RN
• Douglas Smith, M.D.
• Emily Smith
• Jeffrey Nathan Smith, M.D.
• Quinesha Smith
• Sara Jean Smith
• Edward J Snyder Jr., HID
• Mathew J. So, M.D.
• Soaringhigh ABA MN LLC

• Clinical Psychologist in Roseville, MN
• Providers in Roseville, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.