MEDICARE: SHAMECKA SMILEY LAUGHTON LMSW

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	104100000X	Social Worker	112125	NY

General Provider Information

NPI Number	:	1790445120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMECKA SMILEY LAUGHTON LMSW

Provider Business Mailing Address
First Line	:	2015 WILLOW WOOD DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-2133
Country	:	US
Telephone Number	:	929-395-4838
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 WILLOW WOOD DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-2133
Country	:	US
Telephone Number	:	929-395-4838
Fax Number	:

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

Provider Enumeration Date	:	12/27/2021
Last Update Date	:	02/09/2024

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