Provider Demographics
NPI:1588791388
Name:SMITH, JANELLE M (LCSW-R)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2558
Mailing Address - Country:US
Mailing Address - Phone:607-432-8477
Mailing Address - Fax:607-432-3150
Practice Address - Street 1:179 RIVER ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2239
Practice Address - Country:US
Practice Address - Phone:607-432-8477
Practice Address - Fax:607-432-3150
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067946-11041C0700X
NYR0756081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJR00011737 (UHS)Medicare PIN