Provider Demographics
NPI:1578229795
Name:SMITH, KARALYN
Entity Type:Individual
Prefix:
First Name:KARALYN
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 1:6350 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:NY
Mailing Address - Zip Code:13490-1000
Mailing Address - Country:US
Mailing Address - Phone:315-525-2535
Mailing Address - Fax:
Practice Address - Street 1:1550 CHAMPLIN AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-4828
Practice Address - Country:US
Practice Address - Phone:315-235-7621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0834731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical