Provider Demographics
NPI:1366805616
Name:MCNISH-SMITH, LARUE (LADC)
Entity type:Individual
Prefix:
First Name:LARUE
Middle Name:
Last Name:MCNISH-SMITH
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MAIN ST N
Mailing Address - Street 2:SUITE 725
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3840
Mailing Address - Country:US
Mailing Address - Phone:203-681-1212
Mailing Address - Fax:203-519-7979
Practice Address - Street 1:100 MAIN ST N
Practice Address - Street 2:SUITE 725
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3840
Practice Address - Country:US
Practice Address - Phone:203-681-1212
Practice Address - Fax:203-519-7979
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1183101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)