Provider Demographics
NPI:1689769887
Name:SMOLLON, ANN P (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:P
Last Name:SMOLLON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:P
Other - Last Name:PIAZZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:PO BOX 7509
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-0790
Mailing Address - Country:US
Mailing Address - Phone:516-398-8695
Mailing Address - Fax:
Practice Address - Street 1:44 DYCKMAN AVENUE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-398-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR 0391371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical