Provider Demographics
NPI:1962572891
Name:SMITH, ANITA LOUISE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANITA LOUISE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-238-6444
Mailing Address - Fax:718-238-5165
Practice Address - Street 1:9435 RIDGE BLVD
Practice Address - Street 2:JBFCS BAYRIDGE COUNSELING CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-238-6444
Practice Address - Fax:718-238-5165
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039486104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR039486B37OtherHEALTH FIRST
NYR039486B37OtherHEALTH FIRST