Provider Demographics
NPI:1841791332
Name:SMITH, EKEITHEA SHAKEMA (LMSW)
Entity Type:Individual
Prefix:
First Name:EKEITHEA
Middle Name:SHAKEMA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 BROADWAY FL 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-8433
Mailing Address - Country:US
Mailing Address - Phone:347-505-5100
Mailing Address - Fax:
Practice Address - Street 1:260 BROADWAY FL 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-8433
Practice Address - Country:US
Practice Address - Phone:347-505-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102913-1101YM0800X
NY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health