Basic Information
| Provider Information | |||||||||
| NPI: | 1407160872 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | JEWELL | ||||||||
| MiddleName: | JUANITA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 640 W 232ND ST | ||||||||
| Address2: | PRIVATE HOUSE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104633207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188842900 | ||||||||
| FaxNumber: | 7188841772 | ||||||||
| Practice Location | |||||||||
| Address1: | 260 E 161ST ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104513512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189933397 | ||||||||
| FaxNumber: | 7182921980 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2010 | ||||||||
| LastUpdateDate: | 11/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.