Provider Demographics
NPI:1780803494
Name:SMITH, ANN ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:ELIZABETH
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 GREYSTONE AVE
Mailing Address - Street 2:#32A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1937
Mailing Address - Country:US
Mailing Address - Phone:917-359-8635
Mailing Address - Fax:
Practice Address - Street 1:3900 GREYSTONE AVE
Practice Address - Street 2:#32A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1937
Practice Address - Country:US
Practice Address - Phone:917-359-8635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical