MEDICARE: KRISTA SAMANTHA SMITH-HANKE MSS, LSW

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	SW140626	PA

General Provider Information

NPI Number	:	1851179048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA SAMANTHA SMITH-HANKE MSS, LSW

Provider Business Mailing Address
First Line	:	4226 CHESTER AVE APT 2
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-4476
Country	:	US
Telephone Number	:	301-832-8365
Fax Number	:

Provider Business Practice Location Address
First Line	:	3535 MARKET ST STE 3032
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-3313
Country	:	US
Telephone Number	:	215-573-2517
Fax Number	:

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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