Provider Demographics
NPI:1790818227
Name:SMITH, PHILIP W (PHD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 ARBORVIEW
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-1824
Mailing Address - Country:US
Mailing Address - Phone:845-225-6300
Mailing Address - Fax:
Practice Address - Street 1:20 HOSPITAL OVAL W
Practice Address - Street 2:307 CEDARWOOD HALL - WIHD
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1559
Practice Address - Country:US
Practice Address - Phone:914-493-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015335103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist