Provider Demographics
NPI:1407106560
Name:SMITH, JOANNE BUFFY (PHD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:BUFFY
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 W END AVE
Mailing Address - Street 2:5F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3535
Mailing Address - Country:US
Mailing Address - Phone:212-787-2853
Mailing Address - Fax:
Practice Address - Street 1:915 W END AVE
Practice Address - Street 2:5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-3535
Practice Address - Country:US
Practice Address - Phone:212-787-2853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011129-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical