Provider Demographics
NPI:1205083474
Name:SMITH, YVETTE ELIZABETH (CASAC)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BROADWAY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-5408
Mailing Address - Country:US
Mailing Address - Phone:845-562-8255
Mailing Address - Fax:845-562-4140
Practice Address - Street 1:280 BROADWAY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-5408
Practice Address - Country:US
Practice Address - Phone:845-562-8255
Practice Address - Fax:845-562-4140
Is Sole Proprietor?:No
Enumeration Date:2008-08-19
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)