Provider Demographics
NPI:1396092169
Name:SMITH, ROBERT A (LCADC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:EAST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07017-1922
Mailing Address - Country:US
Mailing Address - Phone:973-207-9690
Mailing Address - Fax:
Practice Address - Street 1:450 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07304-4218
Practice Address - Country:US
Practice Address - Phone:201-200-1965
Practice Address - Fax:201-200-1826
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00122100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)