1447355425 NPI number — MS. CYNTHIA ANN CLARK-SMITH M.S.W

Table of content: MS. CYNTHIA ANN CLARK-SMITH M.S.W (NPI 1447355425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447355425 NPI number — MS. CYNTHIA ANN CLARK-SMITH M.S.W

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CLARK-SMITH
Provider First Name:
CYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.W
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CLARK
Provider Other First Name:
CYNTHIA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.W.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1447355425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8513 BAYRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CICERO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13039-9234
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-425-4400
Provider Business Mailing Address Fax Number:
315-425-4861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 IRVING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-425-4400
Provider Business Practice Location Address Fax Number:
315-425-4861
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  1044 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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