Provider Demographics
NPI:1336279983
Name:SMITH, PETER WINSTON (LCSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:WINSTON
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 E 83RD ST
Mailing Address - Street 2:APT. 4C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2803
Mailing Address - Country:US
Mailing Address - Phone:212-744-6468
Mailing Address - Fax:
Practice Address - Street 1:245 E 83RD ST
Practice Address - Street 2:APT. 4C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2803
Practice Address - Country:US
Practice Address - Phone:212-744-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP062340-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical