Provider Demographics
NPI:1841412673
Name:SMITH, EVAN (CAT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 SWEET HOME RD STE 3-5
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2795
Mailing Address - Country:US
Mailing Address - Phone:716-589-1411
Mailing Address - Fax:716-559-1572
Practice Address - Street 1:1412 SWEET HOME RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-2795
Practice Address - Country:US
Practice Address - Phone:716-589-1411
Practice Address - Fax:716-881-2425
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7901198221700000X
NY001118-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist