Provider Demographics
NPI:1669655270
Name:SMITH, NATHAN RICHARD (PHARMD, MFT)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:RICHARD
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHARMD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3392 COUNTY ROAD 46
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8848
Mailing Address - Country:US
Mailing Address - Phone:716-984-5379
Mailing Address - Fax:
Practice Address - Street 1:4472 ELLING RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:NY
Practice Address - Zip Code:14743-9705
Practice Address - Country:US
Practice Address - Phone:315-946-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20 051143183500000X
NY118976-01106H00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program