Provider Demographics
NPI:1871870840
Name:SMALLWOOD, JACQUELINE D (LCSW-R)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:D
Last Name:SMALLWOOD
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HARMONY RD
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:NY
Mailing Address - Zip Code:12563-2730
Mailing Address - Country:US
Mailing Address - Phone:845-878-4238
Mailing Address - Fax:
Practice Address - Street 1:37 HARMONY RD
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:NY
Practice Address - Zip Code:12563-2730
Practice Address - Country:US
Practice Address - Phone:845-878-4238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO494551041C0700X
NY16237581041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool