Provider Demographics
NPI:1326174848
Name:SMYTH, NANCY J (PHD, LCSW, CASAC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:J
Last Name:SMYTH
Suffix:
Gender:F
Credentials:PHD, LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1515
Mailing Address - Country:US
Mailing Address - Phone:716-881-4065
Mailing Address - Fax:716-881-4066
Practice Address - Street 1:434 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1515
Practice Address - Country:US
Practice Address - Phone:716-881-4065
Practice Address - Fax:716-881-4066
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4033101YA0400X
NYR0356141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY213705OtherCOMPSYCH
NY205649OtherVALUE OPTIONS
NY213705OtherCOMPSYCH