Provider Demographics
NPI:1891776118
Name:SMETHURST, DOREEN (LCSW ACSW)
Entity Type:Individual
Prefix:MRS
First Name:DOREEN
Middle Name:
Last Name:SMETHURST
Suffix:
Gender:F
Credentials:LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 MOUNT HOPE AVE
Mailing Address - Street 2:#217
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-442-1090
Mailing Address - Fax:585-586-3622
Practice Address - Street 1:1351 MOUNT HOPE AVE
Practice Address - Street 2:#217
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-442-1090
Practice Address - Fax:585-586-3622
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR02175011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPR0217501OtherEXCELLUS
NY7519396OtherAETNA
NY7519396OtherAETNA