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NPI Code Detail

MEDICARE: CASSANDRA SMITH MS, LSW

MEDICARE: CASSANDRA SMITH MS, LSW
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1104033760
Entity Type Code : Individual
Provider Name (Legal Business Name) : CASSANDRA SMITH MS, LSW
Provider Business Mailing Address
First Line : 6322 HORIZON WAY
Second Line :
City : CHARLESTOWN
State : IN
Zip : 47111-8899
Country : US
Telephone Number : 812-987-7253
Fax Number :
Provider Business Practice Location Address
First Line : 7509 CHARLESTOWN PIKE
Second Line :
City : CHARLESTOWN
State : IN
Zip : 47111-9623
Country : US
Telephone Number : 812-256-4686
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2007
Last Update Date : 01/30/2017

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