Provider Demographics
NPI:1982779492
Name:SMITH, SYLVIA (LCSW)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WHITEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778
Mailing Address - Country:US
Mailing Address - Phone:631-821-1362
Mailing Address - Fax:631-665-0442
Practice Address - Street 1:3 WHITEWOOD DR
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-9323
Practice Address - Country:US
Practice Address - Phone:631-821-1362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025937-11041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02090128Medicaid
NY02090128Medicaid
R33923Medicare UPIN