Healthcare Provider Details

I. General information

NPI: 1730420605
Provider Name (Legal Business Name): JAMES R SMITH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2013
Last Update Date: 03/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 DECATUR AVE
PEEKSKILL NY
10566-2106
US

IV. Provider business mailing address

200 DECATUR AVE
PEEKSKILL NY
10566-2106
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-1591
  • Fax:
Mailing address:
  • Phone: 914-737-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License NumberRO35598-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR 035598-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: