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
1	1041C0700X	Clinical Social Worker	4430C	AL

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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