Provider Demographics
NPI:1083976856
Name:SMITH, DOREEN M
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2714 STATE HIGHWAY 29
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12095-4041
Mailing Address - Country:US
Mailing Address - Phone:518-736-5720
Mailing Address - Fax:518-762-1382
Practice Address - Street 1:2714 STATE HIGHWAY 29
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095-4041
Practice Address - Country:US
Practice Address - Phone:518-736-5720
Practice Address - Fax:518-762-1382
Is Sole Proprietor?:No
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator