Provider Demographics
NPI:1366018723
Name:SMITH, CHANTEL PATRICE
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:PATRICE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32A WOODCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-1916
Mailing Address - Country:US
Mailing Address - Phone:307-274-5960
Mailing Address - Fax:
Practice Address - Street 1:620 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:NY
Practice Address - Zip Code:12144-1300
Practice Address - Country:US
Practice Address - Phone:518-252-7073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker