Provider Demographics
NPI:1003380270
Name:SMITH, LIZABETH ANN (MSW, LCSW-R)
Entity Type:Individual
Prefix:
First Name:LIZABETH
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 PEYSTER ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2510
Mailing Address - Country:US
Mailing Address - Phone:518-209-6250
Mailing Address - Fax:
Practice Address - Street 1:407 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211-1900
Practice Address - Country:US
Practice Address - Phone:518-209-6250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0732141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical