Active NPI
Theodore Vandix Smith III, L.M.S.W.
- Mental Health Counselor
- Flushing, NY
National Provider Identifier
1427203157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 068663-1
- Practice address
- 71-50 Parsons Blvd.
Flushing, NY 11365 - Phone
- (718) 591-6750
- NPI assigned
- Nov 21, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 068663-1 | NY | Primary |
Addresses
Primary practice location
71-50 Parsons Blvd.
Flushing, NY 11365
Mailing address
102-32 189TH Street
Hollis, NY 11423
Phone (718) 454-2152
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 068663-1 | NY | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1227225600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1227225600000",
"number": "1427203157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "102-32 189TH STREET",
"city": "HOLLIS",
"state": "NY",
"postal_code": "11423",
"telephone_number": "718-454-2152"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71-50 PARSONS BLVD.",
"city": "FLUSHING",
"state": "NY",
"postal_code": "11365",
"telephone_number": "718-591-6750"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "THEODORE",
"middle_name": "VANDIX",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "L.M.S.W.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-11-21",
"last_updated": "2008-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "068663-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Flushing, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.