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NPI Code Detail

MEDICARE: SEAN R SMITH

MEDICARE: SEAN R SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerS.1100423OH
2101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.011119OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023257573
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEAN R SMITH
Provider Business Mailing Address
First Line : 6460 HARRISON AVE STE 200
Second Line :
City : CINCINNATI
State : OH
Zip : 45247-7958
Country : US
Telephone Number : 513-941-4999
Fax Number :
Provider Business Practice Location Address
First Line : 1718 CENTRAL PKWY
Second Line :
City : CINCINNATI
State : OH
Zip : 45214-2355
Country : US
Telephone Number : 513-941-4999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2009
Last Update Date : 11/02/2023

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Directions to “ SEAN R SMITH ” Practice Location

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