Provider Demographics
NPI:1437277506
Name:SMITH, RICHARD J (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
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 1:126 MCKINSTRY RD
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:NY
Mailing Address - Zip Code:12525-5133
Mailing Address - Country:US
Mailing Address - Phone:845-256-6456
Mailing Address - Fax:
Practice Address - Street 1:126 MCKINSTRY RD
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:NY
Practice Address - Zip Code:12525-5133
Practice Address - Country:US
Practice Address - Phone:845-256-6456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4610101YA0400X
NY03388011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical