Healthcare Provider Details

I. General information

NPI: 1245313881
Provider Name (Legal Business Name): RENEE SMITH L.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WOODLAND AVE
PHILADELPHIA PA
19104-4551
US

IV. Provider business mailing address

728 WOODLAND AVE
WESTVILLE NJ
08093-2242
US

V. Phone/Fax

Practice location:
  • Phone: 215-627-0238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW012632L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: