Provider Demographics
NPI:1457390023
Name:SMYTH, DAVID M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:M
Last Name:SMYTH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-1313
Mailing Address - Country:US
Mailing Address - Phone:201-805-5528
Mailing Address - Fax:973-763-1365
Practice Address - Street 1:26 W 9TH ST
Practice Address - Street 2:APT 8B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8924
Practice Address - Country:US
Practice Address - Phone:201-805-5528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072643-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7X111Medicare ID - Type UnspecifiedMEDICAR PROVIDER NUMBER