Provider Demographics
NPI:1063519502
Name:SMITH, PHYLLIS ANN
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 LAFAYETTE AVE
Mailing Address - Street 2:APT 4
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216
Mailing Address - Country:US
Mailing Address - Phone:212-686-7500
Mailing Address - Fax:212-951-3391
Practice Address - Street 1:423 EAST 23RD STREET
Practice Address - Street 2:SWS 122
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:212-951-3391
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor