Healthcare Provider Details

I. General information

NPI: 1588803761
Provider Name (Legal Business Name): JULI SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 CELESTE DR
RENSSELAER NY
12144-4431
US

IV. Provider business mailing address

35 CELESTE DR
RENSSELAER NY
12144-4431
US

V. Phone/Fax

Practice location:
  • Phone: 518-477-1266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: