Provider Demographics
NPI:1932957255
Name:BLAKE-SMITH, KANARI (LMHC)
Entity Type:Individual
Prefix:MS
First Name:KANARI
Middle Name:
Last Name:BLAKE-SMITH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 50TH AVE APT 26J
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5783
Mailing Address - Country:US
Mailing Address - Phone:914-413-8840
Mailing Address - Fax:
Practice Address - Street 1:201 50TH AVE APT 26J
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5783
Practice Address - Country:US
Practice Address - Phone:914-413-8840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003489101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health