Provider Demographics
NPI:1407424815
Name:SMITH, CLAY SONGOW I
Entity Type:Individual
Prefix:
First Name:CLAY
Middle Name:SONGOW
Last Name:SMITH
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1O8 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-2409
Mailing Address - Country:US
Mailing Address - Phone:646-908-9562
Mailing Address - Fax:
Practice Address - Street 1:1O8 FOREST RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-2409
Practice Address - Country:US
Practice Address - Phone:646-908-9562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY060757101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor