Provider Demographics
NPI:1790856821
Name:SMELSON, BARI (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARI
Middle Name:
Last Name:SMELSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CENTRAL PARK WEST
Mailing Address - Street 2:1W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3025
Mailing Address - Country:US
Mailing Address - Phone:212-721-5504
Mailing Address - Fax:914-674-2436
Practice Address - Street 1:275 CENTRAL PARK WEST
Practice Address - Street 2:1W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2005
Practice Address - Country:US
Practice Address - Phone:212-721-5504
Practice Address - Fax:914-674-2436
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039167101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4G201Medicare PIN