Provider Demographics
NPI:1639388218
Name:SMITH, MICHELE RAE (LPC, LMHC, NCC)
Entity Type:Individual
Prefix:MS
First Name:MICHELE
Middle Name:RAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WILLOW AVE
Mailing Address - Street 2:#304
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-3200
Mailing Address - Country:US
Mailing Address - Phone:201-876-9402
Mailing Address - Fax:
Practice Address - Street 1:1115 WILLOW AVE
Practice Address - Street 2:#304
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-3200
Practice Address - Country:US
Practice Address - Phone:201-876-9402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00346200101YM0800X
NY782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health