Healthcare Provider Details

I. General information

NPI: 1790158061
Provider Name (Legal Business Name): LAUREN SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2015
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 10TH AVE
MERIDIAN MS
39305-4861
US

IV. Provider business mailing address

4800 10TH AVE
MERIDIAN MS
39305-4861
US

V. Phone/Fax

Practice location:
  • Phone: 845-239-1673
  • Fax:
Mailing address:
  • Phone: 845-239-1673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC10372
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: