Provider Demographics
NPI:1972632628
Name:SMITH, LAMONT SR (CASAC)
Entity Type:Individual
Prefix:MR
First Name:LAMONT
Middle Name:
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14212-1501
Mailing Address - Country:US
Mailing Address - Phone:716-896-7350
Mailing Address - Fax:716-332-1879
Practice Address - Street 1:1131 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14212-1501
Practice Address - Country:US
Practice Address - Phone:716-896-7350
Practice Address - Fax:716-332-1879
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY712852599101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)