Provider Demographics
NPI:1265689558
Name:SMITH, DEBORAH L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 WASHINGTON ST
Mailing Address - Street 2:SUITE 3101
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4084
Mailing Address - Country:US
Mailing Address - Phone:315-767-5753
Mailing Address - Fax:315-788-9001
Practice Address - Street 1:531 WASHINGTON ST
Practice Address - Street 2:SUITE 3101
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4084
Practice Address - Country:US
Practice Address - Phone:315-767-5753
Practice Address - Fax:315-788-9001
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011989174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist