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General NPI Number Information
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NPI Number | 1205131265
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Entity Type | Individual
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Provider Name | JEFFREY D SMITH LCSW-R
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Gender | Male
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Dates
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Enumeration Date | 01/21/2011
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Last Update Date | 01/21/2011
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Provider Practice Location Address
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Address Line | 23 SAINT JOHN ST
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City | MONTICELLO
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State | NY
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Zip | 12701-2149
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Country | US
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Telephone | 845-794-3430
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Fax | 845-794-4969
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Provider Business Mailing Address
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Address Line | PO BOX 4
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City | FERNDALE
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State | NY
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Zip | 12734-0004
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Country | US
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Telephone | 845-794-3430
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Fax | 845-794-4969
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R056850-1
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License Number State | NY
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