Provider Demographics
NPI:1841598356
Name:GIFFORD-SMITH, MARY E (PHD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:GIFFORD-SMITH
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 1:684 PEEKSKILL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-2303
Mailing Address - Country:US
Mailing Address - Phone:845-526-0808
Mailing Address - Fax:845-526-0257
Practice Address - Street 1:1994 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOHEGAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:10547-1231
Practice Address - Country:US
Practice Address - Phone:914-528-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018637-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist