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NPI Code Detail

MEDICARE: MARIA ANTIONETTE SMITH CDCA

MEDICARE: MARIA ANTIONETTE SMITH CDCA
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
1101YA0400XAddiction (Substance Use Disorder) Counselor164199OH

General Provider Information

NPI Number : 1770096752
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA ANTIONETTE SMITH CDCA
Provider Business Mailing Address
First Line : 24101 LAKESHORE BLVD
Second Line : APT 1107
City : EUCLID
State : OH
Zip : 44123
Country : US
Telephone Number : 216-313-8405
Fax Number :
Provider Business Practice Location Address
First Line : 1227 ANSEL RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44108-3323
Country : US
Telephone Number : 216-421-0662
Fax Number : 216-421-0911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2017
Last Update Date : 11/13/2017

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Directions to “ MARIA ANTIONETTE SMITH CDCA” Practice Location

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