MEDICARE: KIMBERLY M 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	ISW01888	RI
2	1041C0700X	Clinical Social Worker	110679	MA

Other Identifiers

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

General Provider Information

NPI Number	:	1043419617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY M SMITH LICSW

Provider Business Mailing Address
First Line	:	455 TOLL GATE RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-2759
Country	:	US
Telephone Number	:	401-273-0641
Fax Number	:	401-273-2919

Provider Business Practice Location Address
First Line	:	215 TOLL GATE RD STE 104
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02886-4463
Country	:	US
Telephone Number	:	401-921-7290
Fax Number	:	401-921-6194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	08/30/2024

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Directions to “ KIMBERLY M SMITH LICSW” Practice Location

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