NPIMap

Organization Active NPI

SMBM, LCSW, PLLC

  • Community/Behavioral Health Agency
  • Fort Edward, NY
National Provider Identifier
1275961237
Registry record updated Oct 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
078314 Issued in NY
Legal business name
SMBM, LCSW, PLLC
Practice address
46 Reynolds Rd
Fort Edward, NY 12828-9244
Phone
(518) 573-0239
NPI assigned
Oct 29, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shannon Brock Myles, LCSW
Title
Owner
Phone
(518) 573-0239

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 078314 NY Primary

Addresses

Primary practice location

46 Reynolds Rd
Fort Edward, NY 12828-9244

Mailing address

10 Foxhurst Dr
Queensbury, NY 12804-8488
Phone (518) 573-0239

Other names 1

  • Adirondack Equine Assisted Psychotherapy, LCSW Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1383004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1383091200000",
    "number": "1275961237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 FOXHURST DR",
            "city": "QUEENSBURY",
            "state": "NY",
            "postal_code": "128048488",
            "telephone_number": "518-573-0239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46 REYNOLDS RD",
            "city": "FORT EDWARD",
            "state": "NY",
            "postal_code": "128289244",
            "telephone_number": "518-573-0239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMBM, LCSW, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-29",
        "last_updated": "2013-10-30",
        "status": "A",
        "authorized_official_last_name": "BROCK MYLES",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "518-573-0239",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NY",
            "license": "078314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adirondack Equine Assisted Psychotherapy, LCSW",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Edward, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.