Provider Demographics
NPI:1790471209
Name:SMITH, TAYLOR CAROLINE (MHC)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CAROLINE
Last Name:SMITH
Suffix:
Gender:
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 DEKALB AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6074
Mailing Address - Country:US
Mailing Address - Phone:210-845-6770
Mailing Address - Fax:
Practice Address - Street 1:249 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3436
Practice Address - Country:US
Practice Address - Phone:347-547-3626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39611101YA0400X
NY18-P130532-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)