Healthcare Provider Details

I. General information

NPI: 1174706105
Provider Name (Legal Business Name): JAMES BRIAN SMITH L.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PINEWILD DR STE 2A
ROCHESTER NY
14606-4200
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-368-6700
  • Fax: 585-368-6767
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078454
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: