Healthcare Provider Details

I. General information

NPI: 1629953708
Provider Name (Legal Business Name): MATTHEW SMITH LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/08/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 ROCKY LN
ASHLAND OH
44805-4701
US

IV. Provider business mailing address

2233 ROCKY LN
ASHLAND OH
44805-4701
US

V. Phone/Fax

Practice location:
  • Phone: 419-281-3716
  • Fax:
Mailing address:
  • Phone: 419-281-3716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2511813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: