Provider Demographics
NPI:1154530269
Name:SMIRNOFF, ALAN M (PSYD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:M
Last Name:SMIRNOFF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 HIGHLAND AVE
Mailing Address - Street 2:SUITE A2
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2525
Mailing Address - Country:US
Mailing Address - Phone:203-271-1900
Mailing Address - Fax:203-699-0907
Practice Address - Street 1:408 HIGHLAND AVE
Practice Address - Street 2:SUITE A2
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2525
Practice Address - Country:US
Practice Address - Phone:203-271-1900
Practice Address - Fax:203-699-0907
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001414103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT620000230Medicare ID - Type Unspecified