Healthcare Provider Details

I. General information

NPI: 1558317164
Provider Name (Legal Business Name): KIM SMITH SLOSMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 BLOOMINGDALE AVE APT 3
AKRON NY
14001-1138
US

IV. Provider business mailing address

17 BLOOMINGDALE AVE APT 3
AKRON NY
14001-1138
US

V. Phone/Fax

Practice location:
  • Phone: 716-517-0270
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001336
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: