Individual
NICOLE SUSAN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
38 BUCKINGHAM DR, HOLBROOK, NY 11741-2880
(631) 738-0311
Mailing address
45 OAKCREST AVE, FARMINGVILLE, NY 11738-2024
(631) 404-7802
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NY
Other
Enumeration date
10/27/2023
Last updated
10/27/2023
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