Provider Demographics
NPI:1275006132
Name:SMITH, TANYIKA MICHELE (LMSW)
Entity Type:Individual
Prefix:
First Name:TANYIKA
Middle Name:MICHELE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 SADORE LN APT 1F
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4836
Mailing Address - Country:US
Mailing Address - Phone:347-416-4673
Mailing Address - Fax:
Practice Address - Street 1:1 SADORE LN APT 1F
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-4836
Practice Address - Country:US
Practice Address - Phone:347-416-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105403-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist