Healthcare Provider Details

I. General information

NPI: 1710893581
Provider Name (Legal Business Name): ALEXA LANI SMITH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 AKRON ST
COPIAGUE NY
11726-2931
US

IV. Provider business mailing address

1375 AKRON ST
COPIAGUE NY
11726-2931
US

V. Phone/Fax

Practice location:
  • Phone: 631-552-4240
  • Fax: 631-552-4241
Mailing address:
  • Phone: 631-552-4240
  • Fax: 631-552-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133099
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: