MEDICARE: MRS. CAROLYN A. SMILEY P.C.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
1	101Y00000X	Counselor	C0900401	OH

General Provider Information

NPI Number	:	1992062707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROLYN A. SMILEY P.C.C

Provider Business Mailing Address
First Line	:	6693 NORTH CHESTNUT ST
Second Line	:	SUITE 235
City	:	RAVENNA
State	:	OH
Zip	:	44266
Country	:	US
Telephone Number	:	330-296-3700
Fax Number	:	330-298-1460

Provider Business Practice Location Address
First Line	:	6693 NORTH CHESTNUT ST
Second Line	:	SUITE 235
City	:	RAVENNA
State	:	OH
Zip	:	44266
Country	:	US
Telephone Number	:	330-296-3700
Fax Number	:	330-298-1460

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

Provider Enumeration Date	:	04/18/2012
Last Update Date	:	02/26/2014

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