Provider Demographics
NPI:1639704984
Name:SMITH, HENRY (MSW, RCPA)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW, RCPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 FOUNTAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-2516
Mailing Address - Country:US
Mailing Address - Phone:929-231-3136
Mailing Address - Fax:718-827-4573
Practice Address - Street 1:236 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-2516
Practice Address - Country:US
Practice Address - Phone:929-231-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist