Provider Demographics
NPI:1629739628
Name:SMITH, REAGHAN T (LMHC)
Entity Type:Individual
Prefix:MS
First Name:REAGHAN
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16834 127TH AVE APT 8A
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3108
Mailing Address - Country:US
Mailing Address - Phone:718-517-0103
Mailing Address - Fax:
Practice Address - Street 1:16834 127TH AVE APT 8A
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3108
Practice Address - Country:US
Practice Address - Phone:718-517-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP113383101YM0800X
NY014190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty