Provider Demographics
NPI:1174584973
Name:SMITH, MARY F (LCSW-R)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WESTLYN CT
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3415
Mailing Address - Country:US
Mailing Address - Phone:518-213-0343
Mailing Address - Fax:518-213-0334
Practice Address - Street 1:3 LEAR JET LN
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2314
Practice Address - Country:US
Practice Address - Phone:518-785-3614
Practice Address - Fax:518-785-8786
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004365-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYOTH000Medicare UPIN
NY38925BMedicare ID - Type Unspecified