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Individual

MRS. ALICE SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LMHC, CASAC

Contact information

Practice address
123 PIKE ST, PORT JERVIS, NY 12771-1824
(845) 856-7576
(845) 856-8231
Mailing address
123 PIKE ST, PORT JERVIS, NY 12771-1824
(845) 856-7576
(845) 856-8231

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
000429
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000429
NEW YORK STATE OFFICE OF PROFESSIONS
NY
01
12588
NYS OASAS
NY
Enumeration date
08/19/2016
Last updated
08/19/2016
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