Provider Demographics
NPI:1235545906
Name:SMITH, DENISE (BS, LCCE, FACCE)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:BS, LCCE, FACCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1717
Mailing Address - Country:US
Mailing Address - Phone:845-300-2961
Mailing Address - Fax:
Practice Address - Street 1:620 ROUTE 303
Practice Address - Street 2:
Practice Address - City:BLAUVELT
Practice Address - State:NY
Practice Address - Zip Code:10913-1170
Practice Address - Country:US
Practice Address - Phone:845-353-2730
Practice Address - Fax:845-353-2358
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12547174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator