Samantha Jade Smith, PSY.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY9680 Issued in FL

Practice address

1200 NE 55TH Blvd
Gainesville, FL 32641

Phone

(561) 386-4231

NPI assigned

Dec 22, 2016

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)

Enrolled

State licenses

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

{
    "created_epoch": "1482364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569196800000",
    "number": "1720523095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 358343",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326358343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NE 55TH BLVD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "32641",
            "telephone_number": "561-386-4231"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4026 NW 34th Dr",
            "address_purpose": "LOCATION",
            "city": "Gainesville",
            "state": "FL",
            "postal_code": "326051493",
            "country_code": "US",
            "telephone_number": "561-386-4231",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SAMANTHA",
        "middle_name": "JADE",
        "name_prefix": "Dr.",
        "credential": "PSY.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-22",
        "last_updated": "2019-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY9680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Daniel Smith II, M.D.
• Robert S. Smith, M.D.
• Roger Smith
• Roger Stuart Smith, D.O.
• Rozanne M Smith, ARNP
• Sarah Smith
• Shantell Smith
• Stephanie G Smith, PH.D.
• Steven Michael Smith, PHARMD, MPH
• Tammy D Smith, LMT

• Clinical Psychologist in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2019; 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.