Basic Information
| Provider Information | |||||||||
| NPI: | 1770644411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KEVIN | ||||||||
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| Credential: | LCSWR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 88 BREEZEWOOD CMN | ||||||||
| Address2: | |||||||||
| City: | EAST AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140511425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162768457 | ||||||||
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| Practice Location | |||||||||
| Address1: | 88 BREEZEWOOD CMN | ||||||||
| Address2: | |||||||||
| City: | EAST AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 140511425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168426713 | ||||||||
| FaxNumber: | 7168420988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 077379 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.