Healthcare Provider Details

I. General information

NPI: 1316742679
Provider Name (Legal Business Name): SMITH CREATIVE ARTS THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2025
Last Update Date: 02/19/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 5TH AVE FL 11
NEW YORK NY
10001-8017
US

IV. Provider business mailing address

100 JUDSON PL
ROCKVILLE CENTRE NY
11570-2812
US

V. Phone/Fax

Practice location:
  • Phone: 917-336-9083
  • Fax:
Mailing address:
  • Phone: 917-336-9083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: AMANDA ASHLEY SMITH
Title or Position: OWNER, ART THERAPIST
Credential: LCAT, ATR-BC
Phone: 917-336-9083