Provider Demographics
NPI:1336383058
Name:WYANT-SMITH, DAWN CORRINE (LMSW, CASAC-G)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:CORRINE
Last Name:WYANT-SMITH
Suffix:
Gender:F
Credentials:LMSW, CASAC-G
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:CORRINE
Other - Last Name:ROBBINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 COURT ST SUITE 42
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815
Mailing Address - Country:US
Mailing Address - Phone:607-337-1600
Mailing Address - Fax:607-334-4519
Practice Address - Street 1:5 COURT ST SUITE 42
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815
Practice Address - Country:US
Practice Address - Phone:607-337-1600
Practice Address - Fax:607-334-4519
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098003104100000X
NY115812-ICADC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01705682Medicaid
NY01705682Medicaid