MEDICARE: MS. KATHLEEN SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1023459310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN SMITH

Provider Business Mailing Address
First Line	:	14202 20TH AVE
Second Line	:	FL. 3
City	:	FLUSHING
State	:	NY
Zip	:	11351-3000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1669 BEDFORD AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-2009
Country	:	US
Telephone Number	:	718-467-7200
Fax Number	:	718-467-7115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	07/15/2013

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