MEDICARE: MS. CHARMAINE MARIA SMITH LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	202109	TX
2	106H00000X	Marriage & Family Therapist	KY0800	KY

General Provider Information

NPI Number	:	1154680270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHARMAINE MARIA SMITH LMFT

Provider Business Mailing Address
First Line	:	PO BOX 6697
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40206-0697
Country	:	US
Telephone Number	:	502-804-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 GOLDSMITH LN STE 208C
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-1038
Country	:	US
Telephone Number	:	502-804-5410
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	03/14/2025

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