Provider Demographics
NPI:1649384827
Name:SMITH, DAPHNE M (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DAPHNE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:NY
Mailing Address - Zip Code:14808-9608
Mailing Address - Country:US
Mailing Address - Phone:585-507-8705
Mailing Address - Fax:
Practice Address - Street 1:13 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:NY
Practice Address - Zip Code:14808-9608
Practice Address - Country:US
Practice Address - Phone:585-507-8705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014003729OtherEXCELLUS
NY103283EUOtherPREFERRED CARE
NY02249154Medicaid
NY3109089OtherVALUE OPTIONS
NYEMOtherEXCELLUS