MEDICARE: ELIZABETH SMITH CREATIVE ARTS THERAPY

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	:	1932975455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH SMITH CREATIVE ARTS THERAPY

Provider Business Mailing Address
First Line	:	1130 BEDFORD AVE # 1002
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-1303
Country	:	US
Telephone Number	:	551-697-3522
Fax Number	:

Provider Business Practice Location Address
First Line	:	1032 BERGEN ST APT 3
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11216-3340
Country	:	US
Telephone Number	:	551-697-3522
Fax Number	:

Authorized Official
Title or Position	:	MEMBER-MANAGER
Name	:	ELIZABETH E SMITH
Credential	:	LCAT, ATR-BC, CCLS
Telephone Number	:	551-697-3522

Provider Enumeration Date	:	11/27/2023
Last Update Date	:	11/27/2023

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