Provider Demographics
NPI:1588840037
Name:SMITH, CATHERINE BECALLO (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:BECALLO
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:BECALLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:890 7TH NORTH ST STE 100&200
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6558
Mailing Address - Country:US
Mailing Address - Phone:315-422-0300
Mailing Address - Fax:315-452-2455
Practice Address - Street 1:890 7TH NORTH ST STE 100&200
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6558
Practice Address - Country:US
Practice Address - Phone:315-422-0300
Practice Address - Fax:315-452-2455
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0791571041C0700X
NY074576104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074576OtherSTATE LICENSE