Healthcare Provider Details

I. General information

NPI: 1609729789
Provider Name (Legal Business Name): TARA SMITH LSW, CAADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2026
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 OLD ROUTE 56 HWY W
HOMER CITY PA
15748-7700
US

IV. Provider business mailing address

790 OLD ROUTE 56 HWY W
HOMER CITY PA
15748-7700
US

V. Phone/Fax

Practice location:
  • Phone: 814-631-3753
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW143585
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW143585
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: