Provider Demographics
NPI:1841774783
Name:SMITH, CONOR O'BRIEN
Entity Type:Individual
Prefix:MR
First Name:CONOR
Middle Name:O'BRIEN
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 S 46TH ST FLOOR 1
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3778
Mailing Address - Country:US
Mailing Address - Phone:717-517-6580
Mailing Address - Fax:
Practice Address - Street 1:22 S 40TH ST SUITE 201B
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-1419
Practice Address - Country:US
Practice Address - Phone:267-440-7066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-17
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015853101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional