Healthcare Provider Details

I. General information

NPI: 1306765227
Provider Name (Legal Business Name): EVAN SMITH LP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COURT ST STE 1412
BROOKLYN NY
11242-1114
US

IV. Provider business mailing address

155 SULLIVAN ST APT 1
BROOKLYN NY
11231-1112
US

V. Phone/Fax

Practice location:
  • Phone: 716-228-6388
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number001286-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: