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General NPI Number Information
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NPI Number | 1811261720
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Entity Type | Individual
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Provider Name | SHANNON LYNN BAUBLITZ-SMITH LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 02/24/2012
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Last Update Date | 01/16/2024
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Provider Practice Location Address
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Address Line | 102 E CECIL AVE SUITE D
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City | NORTH EAST
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State | MD
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Zip | 21901-4057
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Country | US
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Telephone | 443-207-1813
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Fax |
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Provider Business Mailing Address
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Address Line | 56 DRIER LN
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City | PORT DEPOSIT
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State | MD
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Zip | 21904-2010
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Country | US
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Telephone | 575-740-0264
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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 | SWB-2023-0206
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License Number State | NM
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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 |
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License Number State |
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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 | 15676
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License Number State | MD
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