Provider Demographics
NPI:1053342675
Name:SMITH, HELEN I (MD)
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:I
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1038
Mailing Address - Country:US
Mailing Address - Phone:917-733-2262
Mailing Address - Fax:
Practice Address - Street 1:11631 VICTORY BLVD STE 203
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3572
Practice Address - Country:US
Practice Address - Phone:818-901-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG887382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
HB410VMedicare PIN
HB410WMedicare PIN
HB410RMedicare PIN
HB410MMedicare PIN
HB410OMedicare PIN
HB410UMedicare PIN
HB410YMedicare PIN
HB410TMedicare PIN
HB410SMedicare PIN
HB410NMedicare PIN
HB410PMedicare PIN
HB410QMedicare PIN
CAHB410XMedicare PIN