Provider Demographics
NPI:1770592404
Name:VANALLER-SMITH, JOANNE (LCSW-R)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:VANALLER-SMITH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 672
Mailing Address - Street 2:137 EDGE LANE
Mailing Address - City:MIDDLEBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12122-0672
Mailing Address - Country:US
Mailing Address - Phone:518-827-4603
Mailing Address - Fax:
Practice Address - Street 1:314 S MANNING BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1708
Practice Address - Country:US
Practice Address - Phone:518-453-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049174104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049174Medicaid
J400005199Medicare PIN