Healthcare Provider Details

I. General information

NPI: 1710818612
Provider Name (Legal Business Name): KIMBERLY BROOKE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 S KEYSER AVE
TAYLOR PA
18517-9614
US

IV. Provider business mailing address

712 S KEYSER AVE
TAYLOR PA
18517-9614
US

V. Phone/Fax

Practice location:
  • Phone: 570-445-7795
  • Fax:
Mailing address:
  • Phone: 570-445-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW144186
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: