MEDICARE: VICTORIA LYNN 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	997980	OTHER		NATIONAL BOARD OF CERTIFIED COUNSELORS

General Provider Information

NPI Number	:	1669951463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA LYNN SMITH

Provider Business Mailing Address
First Line	:	123 BRUSH HILL RD
Second Line	:
City	:	MILLBROOK
State	:	NY
Zip	:	12545-6466
Country	:	US
Telephone Number	:	845-797-4820
Fax Number	:	845-724-7160

Provider Business Practice Location Address
First Line	:	24 AUSTIN CT FL 2
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12603-3628
Country	:	US
Telephone Number	:	845-206-4046
Fax Number	:

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

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	08/13/2018

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