Healthcare Provider Details

I. General information

NPI: 1437277506
Provider Name (Legal Business Name): RICHARD J SMITH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MCKINSTRY RD
GARDINER NY
12525-5133
US

IV. Provider business mailing address

126 MCKINSTRY RD
GARDINER NY
12525-5133
US

V. Phone/Fax

Practice location:
  • Phone: 845-256-6456
  • Fax:
Mailing address:
  • Phone: 845-256-6456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4610
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0338801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: