Provider Demographics
NPI:1538860705
Name:SMITH, JANET ELAINE (LCSWR)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:ELAINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 1/2 KIRKLAND AVE APT H21
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1446
Mailing Address - Country:US
Mailing Address - Phone:315-941-5804
Mailing Address - Fax:
Practice Address - Street 1:6 1/2 KIRKLAND AVE APT H21
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1446
Practice Address - Country:US
Practice Address - Phone:315-941-5804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO480391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical