Provider Demographics
NPI:1730487265
Name:SMITH, KATHERINE ANN (LCSWR)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
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 1:90 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:RED HOOK
Mailing Address - State:NY
Mailing Address - Zip Code:12571-1540
Mailing Address - Country:US
Mailing Address - Phone:845-758-8101
Mailing Address - Fax:845-758-8102
Practice Address - Street 1:90 W MARKET ST
Practice Address - Street 2:
Practice Address - City:RED HOOK
Practice Address - State:NY
Practice Address - Zip Code:12571-1540
Practice Address - Country:US
Practice Address - Phone:845-877-4100
Practice Address - Fax:845-877-4112
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0526081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical