Healthcare Provider Details

I. General information

NPI: 1699219246
Provider Name (Legal Business Name): ELIZABETH SMITH MS, RN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 12/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 E 11TH ST SUITE 523
NEW YORK NY
10003-6811
US

IV. Provider business mailing address

80 E 11TH ST SUITE 523
NEW YORK NY
10003-6811
US

V. Phone/Fax

Practice location:
  • Phone: 917-544-5670
  • Fax:
Mailing address:
  • Phone: 917-544-5670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberM326221-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: