MEDICARE: MR. JOSEPH SMITH LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	009188	NY

General Provider Information

NPI Number	:	1477902328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH SMITH LMHC

Provider Business Mailing Address
First Line	:	450 LEXINGTON AVE FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-3912
Country	:	US
Telephone Number	:	212-267-2670
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 LEXINGTON AVE FL 4
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-3912
Country	:	US
Telephone Number	:	212-267-2670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	03/20/2019

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