Individual
GINA MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA CLINICAL PSY
Contact information
Practice address
135 N UNION ST, OLEAN, NY 14760-2736
(716) 375-7500
(716) 701-6853
Mailing address
135 N UNION ST, OLEAN, NY 14760-2736
(716) 375-7500
(716) 701-6853
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
021512
NY
103TH0004X
Health Psychologist
021512
NY
Other
Enumeration date
10/02/2009
Last updated
11/29/2016
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