Healthcare Provider Details

I. General information

NPI: 1992934491
Provider Name (Legal Business Name): ANGELA MARIE SMITH MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7701 W KILGORE AVE SUITE 6
YORKTOWN IN
47396-9290
US

IV. Provider business mailing address

1923 COPELAND FARMS DR
GREENFIELD IN
46140-7112
US

V. Phone/Fax

Practice location:
  • Phone: 765-287-8477
  • Fax:
Mailing address:
  • Phone: 317-462-8950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33005036A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: