Provider Demographics
NPI:1992718415
Name:SMITH, NATHANIEL (LCSW-R)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:MR
Other - First Name:NATHANIEL
Other - Middle Name:
Other - Last Name:SMITH-MARRONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-R
Mailing Address - Street 1:79 SLEEPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SLEEPY HOLLOW
Mailing Address - State:NY
Mailing Address - Zip Code:10591-1518
Mailing Address - Country:US
Mailing Address - Phone:917-538-3532
Mailing Address - Fax:
Practice Address - Street 1:351 MANVILLE RD STE 101
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2166
Practice Address - Country:US
Practice Address - Phone:917-538-3532
Practice Address - Fax:844-965-9672
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYSWL-3927321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNX20201591Medicare PIN