Healthcare Provider Details

I. General information

NPI: 1346469491
Provider Name (Legal Business Name): SUSAN RENEE SMITH M.ED, P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 BATAVIA PIKE
CINCINNATI OH
45244-1518
US

IV. Provider business mailing address

3806 BROTHERTON RD
CINCINNATI OH
45209-1504
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-1555
  • Fax: 513-688-8155
Mailing address:
  • Phone: 513-752-1555
  • Fax: 513-688-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC8309
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: