Provider Demographics
NPI:1922080373
Name:SMITH, BRUCE G (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 BROADWAY
Mailing Address - Street 2:THE LEAGUE FOR THE HARD OF HEARING, 6TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1607
Mailing Address - Country:US
Mailing Address - Phone:917-305-7710
Mailing Address - Fax:
Practice Address - Street 1:50 BROADWAY
Practice Address - Street 2:THE LEAGUE FOR THE HARD OF HEARING, 6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1607
Practice Address - Country:US
Practice Address - Phone:917-305-7710
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0392281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY5521Medicare ID - Type Unspecified