Healthcare Provider Details

I. General information

NPI: 1871407114
Provider Name (Legal Business Name): MARYKATHLEEN SMITH LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W 5TH AVE APT 103
CONSHOHOCKEN PA
19428-1688
US

IV. Provider business mailing address

130 W 5TH AVE APT 103
CONSHOHOCKEN PA
19428-1688
US

V. Phone/Fax

Practice location:
  • Phone: 215-837-0188
  • Fax:
Mailing address:
  • Phone: 215-837-0188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberAPC002874
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: