Provider Demographics
NPI:1275748451
Name:SMITH, HYRUM CANNON (LMSW)
Entity Type:Individual
Prefix:DR
First Name:HYRUM
Middle Name:CANNON
Last Name:SMITH
Suffix:
Gender:M
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 CIVIC CENTER PLZ
Mailing Address - Street 2:SUITE 530
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3156
Mailing Address - Country:US
Mailing Address - Phone:845-462-1288
Mailing Address - Fax:845-462-1291
Practice Address - Street 1:1951 W ARROYO VISTA DRIVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:11003-8106
Practice Address - Country:US
Practice Address - Phone:516-770-5490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069738-1 2005104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker