Active NPI
Charles Edward Smith III, PHD
- Clinical Psychologist
- Evansville, IN
National Provider Identifier
1942707625
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20040012A
- Practice address
- 3400 Lincoln Ave
Evansville, IN 47714-0147 - Phone
- (812) 469-6800
- NPI assigned
- Apr 10, 2018
- 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 | 20040012A | IN | Primary |
Addresses
Primary practice location
3400 Lincoln Ave
Evansville, IN 47714-0147
Mailing address
3400 Lincoln Ave
Evansville, IN 47714-0146
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 |
|---|---|---|---|
| 20040012A | IN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1523318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1523318400000",
"number": "1942707625",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3400 LINCOLN AVE",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477140146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 LINCOLN AVE",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477140147",
"telephone_number": "812-469-6800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "CHARLES",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"name_suffix": "III",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-10",
"last_updated": "2018-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20040012A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.