Healthcare Provider Details

I. General information

NPI: 1952482937
Provider Name (Legal Business Name): SANDY LYNN SMITH LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 W MARKET ST
SNOW HILL MD
21863-1127
US

IV. Provider business mailing address

510 MONTICELLO AVE
SALISBURY MD
21801-6145
US

V. Phone/Fax

Practice location:
  • Phone: 410-632-4510
  • Fax:
Mailing address:
  • Phone: 410-749-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberG09333
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: