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NPI Code Detail

MEDICARE: ANGELINA SMITH LCSW, LAC

MEDICARE: ANGELINA SMITH LCSW, LAC
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 WorkerCSW.09927209CO
2101YA0400XAddiction (Substance Use Disorder) CounselorACD.0001686CO

General Provider Information

NPI Number : 1073007183
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELINA SMITH LCSW, LAC
Provider Business Mailing Address
First Line : 2929 W 10TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80204-3363
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2929 W 10TH AVE
Second Line :
City : DENVER
State : CO
Zip : 80204-3363
Country : US
Telephone Number : 303-504-1200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2018
Last Update Date : 08/02/2023

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