Provider Demographics
NPI:1710319215
Name:SMITH, ADRIENNE (MSLAC)
Entity Type:Individual
Prefix:MS
First Name:ADRIENNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSLAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 FISHCREEK RD
Mailing Address - Street 2:#3
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477-3440
Mailing Address - Country:US
Mailing Address - Phone:917-557-1199
Mailing Address - Fax:
Practice Address - Street 1:11 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1417
Practice Address - Country:US
Practice Address - Phone:917-557-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004915-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist