Healthcare Provider Details

I. General information

NPI: 1790471209
Provider Name (Legal Business Name): TAYLOR CAROLINE SMITH LMHC, CASAC -A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 PENNSYLVANIA AVE
BROOKLYN NY
11207-3436
US

IV. Provider business mailing address

249 PENNSYLVANIA AVE
BROOKLYN NY
11207-3436
US

V. Phone/Fax

Practice location:
  • Phone: 347-547-3626
  • Fax:
Mailing address:
  • Phone: 347-547-3626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018025
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number39611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: