Provider Demographics
NPI:1720367550
Name:SMITH, CHRISTOPHER LENNON
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LENNON
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 WHITE PLAINS RD STE 510
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5152
Mailing Address - Country:US
Mailing Address - Phone:914-345-5900
Mailing Address - Fax:
Practice Address - Street 1:20 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3713
Practice Address - Country:US
Practice Address - Phone:914-345-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023438103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist