Healthcare Provider Details

I. General information

NPI: 1619696739
Provider Name (Legal Business Name): SHALANA SMITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ELMONT RD
ELMONT NY
11003-1603
US

IV. Provider business mailing address

PO BOX 1289
BALDWIN NY
11510-0889
US

V. Phone/Fax

Practice location:
  • Phone: 347-625-9985
  • Fax:
Mailing address:
  • Phone: 516-838-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017592
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: