Provider Demographics
NPI:1568522308
Name:SMITH, PH.D., SHIRLEY (SHIRLEY SMITH, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:
Last Name:SMITH, PH.D.
Suffix:
Gender:F
Credentials:SHIRLEY SMITH, PHD
Other - Prefix:DR
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:SMITH, PH.D.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SHIRLEY SMITH, PHD
Mailing Address - Street 1:19 W 34TH ST RM 920
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-3006
Mailing Address - Country:US
Mailing Address - Phone:212-564-6544
Mailing Address - Fax:212-330-8039
Practice Address - Street 1:19 W 34TH ST RM 920
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:917-885-1236
Practice Address - Fax:212-330-8039
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0271541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical