Provider Demographics
NPI:1922840263
Name:SMITH, DARLEEN (CASAC-M)
Entity type:Individual
Prefix:
First Name:DARLEEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CASAC-M
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 OXHEAD RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2145
Mailing Address - Country:US
Mailing Address - Phone:631-495-3311
Mailing Address - Fax:
Practice Address - Street 1:42 OXHEAD RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2145
Practice Address - Country:US
Practice Address - Phone:631-495-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23979101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)