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General NPI Number Information
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NPI Number | 1376156844
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Entity Type | Individual
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Provider Name | KELLY VERMEEREN-SMITH
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Gender | Female
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Dates
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Enumeration Date | 08/25/2020
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Last Update Date | 03/03/2022
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Provider Practice Location Address
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Address Line | 65 BRYDEN ST
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City | PITTSTON
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State | PA
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Zip | 18640-3450
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Country | US
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Telephone | 570-225-9229
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Fax |
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Provider Business Mailing Address
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Address Line | 514 E GRANT ST
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City | OLYPHANT
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State | PA
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Zip | 18447-1917
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Country | US
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Telephone | 570-851-9711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CW021632
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License Number State | PA
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