Provider Demographics
NPI:1053398453
Name:SMITH, FREDERICK JAMES (PHD)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JAMES
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 LAKEVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-2268
Mailing Address - Country:US
Mailing Address - Phone:518-883-5069
Mailing Address - Fax:518-862-1668
Practice Address - Street 1:1A PINE WEST PLZ
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5556
Practice Address - Country:US
Practice Address - Phone:518-862-1665
Practice Address - Fax:518-862-1668
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical