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General NPI Number Information
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NPI Number | 1699433680
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Entity Type | Individual
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Provider Name | KRISTEN D SMITH LCSW
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Gender | Female
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 169 ANTHOINE ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4452
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Country | US
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Telephone | 207-671-7572
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Fax |
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Provider Business Mailing Address
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Address Line | 169 ANTHOINE ST
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City | SOUTH PORTLAND
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State | ME
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Zip | 04106-4452
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Country | US
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Telephone | 207-671-7572
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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 | SW15759
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15013
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 14209558-3501
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LC22711
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License Number State | ME
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