Provider Demographics
NPI:1710045471
Name:SMALTZ, KAREN JACKSON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:JACKSON
Last Name:SMALTZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3965 SEDGWICK AVE
Mailing Address - Street 2:3A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3104
Mailing Address - Country:US
Mailing Address - Phone:718-548-0099
Mailing Address - Fax:718-548-0099
Practice Address - Street 1:3600 JEROME AVE
Practice Address - Street 2:BXMHC
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-1052
Practice Address - Country:US
Practice Address - Phone:718-881-7600
Practice Address - Fax:718-654-8735
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048688-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1H381Medicare ID - Type Unspecified