Provider Demographics
NPI:1134599236
Name:SMITH, KALISHA J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KALISHA
Middle Name:J
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KALISHA
Other - Middle Name:J
Other - Last Name:CARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1080 BERGEN ST STE 122
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-3340
Mailing Address - Country:US
Mailing Address - Phone:929-429-4733
Mailing Address - Fax:
Practice Address - Street 1:1080 BERGEN ST STE 122
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-3340
Practice Address - Country:US
Practice Address - Phone:929-429-4733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095805104100000X, 1041C0700X
NY27062731041S0200X
NY0884241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool