Provider Demographics
NPI:1952946543
Name:POWELL-SMITH, MAUREEN (COUNSLOR)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:POWELL-SMITH
Suffix:
Gender:F
Credentials:COUNSLOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14604-2303
Mailing Address - Country:US
Mailing Address - Phone:585-262-4330
Mailing Address - Fax:585-262-4826
Practice Address - Street 1:33 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14604-2303
Practice Address - Country:US
Practice Address - Phone:585-262-4330
Practice Address - Fax:585-262-4826
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)