Provider Demographics
NPI:1922156041
Name:SMART, WILLIAM WILSON I (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WILSON
Last Name:SMART
Suffix:I
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:65 CENTRAL PARK W
Mailing Address - Street 2:1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6007
Mailing Address - Country:US
Mailing Address - Phone:212-787-6674
Mailing Address - Fax:212-721-3345
Practice Address - Street 1:65 CENTRAL PARK W
Practice Address - Street 2:1D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6007
Practice Address - Country:US
Practice Address - Phone:212-787-6674
Practice Address - Fax:212-721-3345
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO32407-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN91501Medicaid
NYN91501Medicaid