Healthcare Provider Details

I. General information

NPI: 1144460437
Provider Name (Legal Business Name): NANCY C SMITH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAMS US ARMY HEALTH CLINIC UNIT 45011 ATTN: MCJA-BHS
CAMP ZAMA APO
AP
JP

IV. Provider business mailing address

USAG-J UNIT 45013 B0X 2363
CAMP ZAMA APO
AP
JP

V. Phone/Fax

Practice location:
  • Phone: 01181464074610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00941809
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: