Provider Demographics
NPI:1851932149
Name:SMITH-WILSON, ADANNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ADANNA
Middle Name:
Last Name:SMITH-WILSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 GRAMATAN AVE APT 1K
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-2922
Mailing Address - Country:US
Mailing Address - Phone:914-494-8211
Mailing Address - Fax:
Practice Address - Street 1:485 GRAMATAN AVE APT 1K
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-2922
Practice Address - Country:US
Practice Address - Phone:914-494-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0830751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical