Provider Demographics
NPI:1437210549
Name:SMART, MALINDA MARIE
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:MARIE
Last Name:SMART
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 1:2249 STATE ROUTE 245
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:NY
Mailing Address - Zip Code:14561-9587
Mailing Address - Country:US
Mailing Address - Phone:518-569-9545
Mailing Address - Fax:
Practice Address - Street 1:2249 STATE ROUTE 245
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:NY
Practice Address - Zip Code:14561-9587
Practice Address - Country:US
Practice Address - Phone:518-569-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077395104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker