MEDICARE: MR. BRUCE G SMITH LCSW

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	1041C0700X	Clinical Social Worker	R039228	NY

General Provider Information

NPI Number	:	1922080373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRUCE G SMITH LCSW

Provider Business Mailing Address
First Line	:	50 BROADWAY
Second Line	:	THE LEAGUE FOR THE HARD OF HEARING, 6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10004-1607
Country	:	US
Telephone Number	:	917-305-7710
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 BROADWAY
Second Line	:	THE LEAGUE FOR THE HARD OF HEARING, 6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10004-1607
Country	:	US
Telephone Number	:	917-305-7710
Fax Number	:

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/08/2007

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