Healthcare Provider Details

I. General information

NPI: 1821445941
Provider Name (Legal Business Name): ALLAN D SMITH JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

998 CROOKED HILL RD
WEST BRENTWOOD NY
11717-1019
US

IV. Provider business mailing address

2A EVERETT ST
LYNBROOK NY
11563-3231
US

V. Phone/Fax

Practice location:
  • Phone: 631-761-3309
  • Fax:
Mailing address:
  • Phone: 631-664-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number101399
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: