Provider Demographics
NPI:1285391243
Name:SMITH, MEGAN MAE (MT-BC, LCAT, IMH-E)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MT-BC, LCAT, IMH-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2261 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7602
Mailing Address - Country:US
Mailing Address - Phone:516-242-6504
Mailing Address - Fax:
Practice Address - Street 1:2261 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7602
Practice Address - Country:US
Practice Address - Phone:516-242-6504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001958225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist