Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 011131 | NY |
N | 103T00000X | Psychologist | 011131 | NY |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | 011131 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 011131 | NY |
Y | 103TC0700X | Clinical Psychologist | 011131 | NY |
NPI | 1518060649 |
---|---|
Provider Name | Dr. Steven H Smith |
First Address | Denver, NY 12421 |
Second Address | Denver, NY 12421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 09/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01450100 | (05) | NY |