Provider Demographics
NPI:1437514767
Name:SMITH, MARY ANN
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
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 1:280 WEST 118TH STREET
Mailing Address - Street 2:APT 12A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026
Mailing Address - Country:US
Mailing Address - Phone:718-483-2427
Mailing Address - Fax:
Practice Address - Street 1:280 W 118TH ST
Practice Address - Street 2:APT 12A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-1616
Practice Address - Country:US
Practice Address - Phone:718-483-2427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool