Healthcare Provider Details

I. General information

NPI: 1487319810
Provider Name (Legal Business Name): NICOLE LOUISE SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE # 6B
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

950 SKOKIE BLVD STE 208
NORTHBROOK IL
60062-4017
US

V. Phone/Fax

Practice location:
  • Phone: 630-967-8749
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLCSW131266
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149.027780
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: