Healthcare Provider Details

I. General information

NPI: 1972871549
Provider Name (Legal Business Name): JENETTE BONGIORNO SMITH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 12/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 S LINDEN RD
FLINT MI
48532-5483
US

IV. Provider business mailing address

2360 S LINDEN RD
FLINT MI
48532-5483
US

V. Phone/Fax

Practice location:
  • Phone: 810-720-2913
  • Fax: 810-720-3296
Mailing address:
  • Phone: 810-720-2913
  • Fax: 810-720-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801090597
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: