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NPI Code Detail

MEDICARE: KYLE SMITH LICSW

MEDICARE:   KYLE  SMITH  LICSW
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
11041C0700XClinical Social Worker4430CAL

General Provider Information

NPI Number : 1023708997
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE SMITH LICSW
Provider Business Mailing Address
First Line : 542 W CLEVELAND AVE
Second Line :
City : FLORENCE
State : AL
Zip : 35630-2046
Country : US
Telephone Number : 256-762-3964
Fax Number :
Provider Business Practice Location Address
First Line : 542 W CLEVELAND AVE
Second Line :
City : FLORENCE
State : AL
Zip : 35630-2046
Country : US
Telephone Number : 256-762-3964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2023
Last Update Date : 05/12/2023

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Directions to “ KYLE SMITH LICSW” Practice Location

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