Provider Demographics
NPI:1427762863
Name:SMITH, ANNA CAROLINE
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:CAROLINE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 VALLEY PL APT 1
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1312
Mailing Address - Country:US
Mailing Address - Phone:518-929-4646
Mailing Address - Fax:
Practice Address - Street 1:22 VALLEY PL APT 1
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1312
Practice Address - Country:US
Practice Address - Phone:518-929-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0864461041C0700X
NJ44SC058773001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical