=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447652375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE SMITH LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2014
-----------------------------------------------------
Last Update Date | 09/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 289 INDEPENDENCE BLVD SUITE 312
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-5493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-385-0684
-----------------------------------------------------
Fax | 757-493-5456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 297 INDEPENDENCE BLVD SUITE 126
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23462-2911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-385-0511
-----------------------------------------------------
Fax | 757-473-5161
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904008502
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------