Provider Demographics
NPI:1952494866
Name:SMITH, SARAH D (PSYD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 JEFFERSON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1148
Mailing Address - Country:US
Mailing Address - Phone:845-791-8800
Mailing Address - Fax:
Practice Address - Street 1:64 JEFFERSON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1148
Practice Address - Country:US
Practice Address - Phone:845-791-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7044103TC0700X
NY020374103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4724Medicare ID - Type Unspecified