Provider Demographics
NPI:1992997902
Name:SMITH, ALANZO H (EDD PD MA)
Entity type:Individual
Prefix:DR
First Name:ALANZO
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:EDD PD MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OVINGTON CIRCLE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-334-2253
Mailing Address - Fax:
Practice Address - Street 1:7 SHELTER ROCK RD
Practice Address - Street 2:
Practice Address - City:MANHASSETT
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-627-9350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000439101YM0800X
NY000470106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health