Provider Demographics
NPI:1346831492
Name:SMAGLER, KELSIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:L
Last Name:SMAGLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 SKILLMAN AVE APT 3C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-1643
Mailing Address - Country:US
Mailing Address - Phone:516-578-9940
Mailing Address - Fax:
Practice Address - Street 1:234 SKILLMAN AVE APT 3C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-1643
Practice Address - Country:US
Practice Address - Phone:516-578-9940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0869481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical