Healthcare Provider Details

I. General information

NPI: 1396912606
Provider Name (Legal Business Name): MILENA SMITH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 GIDDINGS AVE SUITE 33
ANNAPOLIS MD
21401-1418
US

IV. Provider business mailing address

716 GIDDINGS AVE SUITE 33
ANNAPOLIS MD
21401-1418
US

V. Phone/Fax

Practice location:
  • Phone: 717-428-0552
  • Fax: 717-428-0518
Mailing address:
  • Phone: 717-428-0552
  • Fax: 717-428-0518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberD60094
License Number StateMD

VIII. Authorized Official

Name: KIM ERSKINE
Title or Position: BILLING MANAGER
Credential:
Phone: 717-428-0552