MEDICARE: LA MONTE SMITH MSW

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1396084950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LA MONTE SMITH MSW

Provider Business Mailing Address
First Line	:	4276 N 68TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1117
Country	:	US
Telephone Number	:	414-393-4832
Fax Number	:	414-393-4815

Provider Business Practice Location Address
First Line	:	4920 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2321
Country	:	US
Telephone Number	:	414-393-4832
Fax Number	:	414-393-4815

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

Provider Enumeration Date	:	02/01/2013
Last Update Date	:	02/01/2013

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