Healthcare Provider Details

I. General information

NPI: 1790919686
Provider Name (Legal Business Name): JOAN B. SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 05/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 PUBLIC LANDING ROAD WORCESTER COUNTY HEALTH DEPARTMENT
SNOW HILL MD
21863
US

IV. Provider business mailing address

1702 SOMERS DR
SALISBURY MD
21804-8659
US

V. Phone/Fax

Practice location:
  • Phone: 410-632-1100
  • Fax: 410-632-0906
Mailing address:
  • Phone: 410-546-1410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number08292
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: