Provider Demographics
NPI:1003923392
Name:SMITH, ELLEN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-0086
Mailing Address - Country:US
Mailing Address - Phone:845-485-2004
Mailing Address - Fax:845-622-3851
Practice Address - Street 1:31 COLLEGEVIEW AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2406
Practice Address - Country:US
Practice Address - Phone:845-485-2004
Practice Address - Fax:845-622-3851
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0338761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical