Provider Demographics
NPI:1790711893
Name:SMITH, ROBERT TAFT JR (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:TAFT
Last Name:SMITH
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PENNAQUID RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-1118
Mailing Address - Country:US
Mailing Address - Phone:631-928-3840
Mailing Address - Fax:
Practice Address - Street 1:115 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-3619
Practice Address - Country:US
Practice Address - Phone:631-234-7807
Practice Address - Fax:631-234-8039
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069865-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical