Provider Demographics
NPI:1265685028
Name:SMART, ANTOINETTE PATRICIA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANTOINETTE
Middle Name:PATRICIA
Last Name:SMART
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 1:772 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2728
Mailing Address - Country:US
Mailing Address - Phone:718-421-3982
Mailing Address - Fax:718-421-3982
Practice Address - Street 1:592 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5539
Practice Address - Country:US
Practice Address - Phone:718-342-0060
Practice Address - Fax:718-342-1882
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063667104100000X
NY0751461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker