Provider Demographics
NPI:1710130851
Name:SMITHERS, LAMELLE (CASAC)
Entity Type:Individual
Prefix:
First Name:LAMELLE
Middle Name:
Last Name:SMITHERS
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3707
Mailing Address - Country:US
Mailing Address - Phone:212-864-4128
Mailing Address - Fax:212-864-7987
Practice Address - Street 1:931 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3707
Practice Address - Country:US
Practice Address - Phone:212-864-4128
Practice Address - Fax:212-864-7987
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18058101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18058OtherCREDENTIALED ALCOHOL AND SUBSTANCE ABUSE COUNSELOR