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NPI Code Detail

MEDICARE: MS. CAROLINE RAE RUSSELL SMITH LCSW-R

MEDICARE: MS. CAROLINE RAE RUSSELL SMITH LCSW-R
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
11041C0700XClinical Social Worker070617-1NY

General Provider Information

NPI Number : 1730230186
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CAROLINE RAE RUSSELL SMITH LCSW-R
Provider Business Mailing Address
First Line : 81 ASH ST
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-3903
Country : US
Telephone Number : 518-584-0730
Fax Number :
Provider Business Practice Location Address
First Line : 58 HENRY ST
Second Line :
City : SARATOGA SPRINGS
State : NY
Zip : 12866-3232
Country : US
Telephone Number : 518-857-9361
Fax Number : 518-581-3182
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2007
Last Update Date : 07/08/2007

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