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NPI Code Detail

MEDICARE: SMITH PSYCHOTHERAPY ASSOCIATES, S.C.

MEDICARE: SMITH PSYCHOTHERAPY ASSOCIATES, S.C.
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
11041C0700XClinical Social Worker149000032IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11114926235OTHERILNPI TYPE I

General Provider Information

NPI Number : 1609298702
Entity Type Code : Organization
Provider Name (Legal Business Name) : SMITH PSYCHOTHERAPY ASSOCIATES, S.C.
Provider Business Mailing Address
First Line : 419 LAUREN LN
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-3519
Country : US
Telephone Number : 847-363-5845
Fax Number : 847-383-7753
Provider Business Practice Location Address
First Line : 500 LAKE COOK RD STE 350
Second Line :
City : DEERFIELD
State : IL
Zip : 60015-5268
Country : US
Telephone Number : 847-363-5845
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MR. ROBERT JOEL SMITH
Credential : LCSW
Telephone Number : 847-824-8366
Provider Enumeration Date : 01/09/2014
Last Update Date : 08/24/2022

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