=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619086295
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MINYA LINET SMITH MSSA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23240 CHAGRIN BLVD SUITE 500
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-292-6007
-----------------------------------------------------
Fax | 216-292-7352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23240 CHAGRIN BLVD SUITE 500
-----------------------------------------------------
City | BEACHWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44122-5404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-292-6007
-----------------------------------------------------
Fax | 216-292-7352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | S0600510
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------