Most Relevant Information
Provider Data
| NPI Number: | 1003495409 |
| Provider Name: | GARY TYQUAN SMITH |
| Entity Type: | Individual |
| Taxonomy Code: | 101Y00000X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/05/2021 |
| Last Updated: | 04/05/2021 |
Provider Practice Location
400 DOANSBURG RD
BREWSTER
NY
10509
Practice Location Phone/Fax
| Phone: | 8452792995 |
| Fax: |
Provider Mailing Location
400 DOANSBURG RD
BREWSTER
NY
10509
Provider Mailing Phone/Fax
| Phone: | 8452792995 |
| Fax: |