Provider Demographics
NPI:1457482093
Name:SMITH, MARK LLEWELLYN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LLEWELLYN
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 1:77 W 85TH ST
Mailing Address - Street 2:4A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4152
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 W 79TH ST
Practice Address - Street 2:2B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6421
Practice Address - Country:US
Practice Address - Phone:212-591-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0619641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical