Provider Demographics
NPI:1518060649
Name:SMITH, STEVEN H (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2954 COUNTY RTE 36
Mailing Address - Street 2:P.O. BOX 101
Mailing Address - City:DENVER
Mailing Address - State:NY
Mailing Address - Zip Code:12421
Mailing Address - Country:US
Mailing Address - Phone:607-326-7718
Mailing Address - Fax:607-326-3530
Practice Address - Street 1:2954 COUNTY RTE 36
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NY
Practice Address - Zip Code:12421
Practice Address - Country:US
Practice Address - Phone:607-326-7718
Practice Address - Fax:607-326-3530
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TA0400X, 103TB0200X
NY011131103TC0700X, 103T00000X, 103TA0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01450100Medicaid
NYV94662Medicare ID - Type UnspecifiedCLINCIAL PSYCHOLOGIST
NY01450100Medicaid