Healthcare Provider Details

I. General information

NPI: 1427924513
Provider Name (Legal Business Name): OLIVIA CAROLINE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MAIN ST
BINGHAMTON NY
13905-2522
US

IV. Provider business mailing address

165 MAIN ST STE A
CORTLAND NY
13045-3191
US

V. Phone/Fax

Practice location:
  • Phone: 607-729-6206
  • Fax: 607-729-6206
Mailing address:
  • Phone: 607-753-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP136755
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: