Provider Demographics
NPI:1255393260
Name:INSONIA-SMITH, REBECCA S (LCSWR)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:S
Last Name:INSONIA-SMITH
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 LAMPMAN RD
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-1886
Mailing Address - Country:US
Mailing Address - Phone:518-669-9437
Mailing Address - Fax:
Practice Address - Street 1:135 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4532
Practice Address - Country:US
Practice Address - Phone:518-584-9030
Practice Address - Fax:518-581-1709
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069966-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD3510Medicare ID - Type UnspecifiedPROVIDER NUMBER
NYP74415Medicare UPIN