Provider Demographics
NPI:1073146478
Name:SMITH, DANIEL J (LCSW LCADC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645-2205
Mailing Address - Country:US
Mailing Address - Phone:201-746-0120
Mailing Address - Fax:
Practice Address - Street 1:52 PARK AVE
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-1277
Practice Address - Country:US
Practice Address - Phone:201-822-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00138400101YA0400X
NJ44SC053488001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)