Eboni Marie Smith

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

0704013232 Issued in VA

Practice address

4121 Lincoln St Apt 2
Gary, IN 46408-2560

Phone

(872) 301-0893

NPI assigned

Jun 29, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687996800000",
    "number": "1477230589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 LINCOLN ST APT 2",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464082560",
            "telephone_number": "872-301-0893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 LINCOLN ST APT 2",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464082560",
            "telephone_number": "872-301-0893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "EBONI",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-06-29",
        "certification_date": "2023-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "VA",
            "license": "0704013232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George D Smalls, M.D.
• Tiffany Smiley, MSN, FNP-BC
• Jo Marie Smith-Shaffer
• Clifton Smith, LCSW
• Darcelmarie Smith, MA,CADC,MISA
• Emanuel Smith
• Fatima Smith
• Jeannette L. Smith
• Lovea Smith
• Rodney D Smith, P.T.A.

• Cognitive & Behavioral Psychologist in Gary, IN
• Providers in Gary, IN by specialty
• Cognitive & Behavioral Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.