Provider Demographics
NPI:1780745174
Name:SMITH, GILBERT A (PHD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
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 112
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-0112
Mailing Address - Country:US
Mailing Address - Phone:856-728-4464
Mailing Address - Fax:856-629-7468
Practice Address - Street 1:504 SICKLERVILLE RD
Practice Address - Street 2:2ND. FLOOR
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2626
Practice Address - Country:US
Practice Address - Phone:856-728-4464
Practice Address - Fax:856-629-7468
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC01029400101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088001Medicare ID - Type UnspecifiedMEDICARE ID #