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NPI Code Detail

MEDICARE: JAZMIN SMITH LICSW

MEDICARE: JAZMIN 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
1101YM0800XMental Health Counselor
2171M00000XCase Manager/Care Coordinator
31041C0700XClinical Social Worker0890135005VT

General Provider Information

NPI Number : 1134641764
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAZMIN SMITH LICSW
Provider Business Mailing Address
First Line : 437 S MAIN ST
Second Line :
City : BRADFORD
State : VT
Zip : 05033-9196
Country : US
Telephone Number : 802-222-9317
Fax Number :
Provider Business Practice Location Address
First Line : 437 S MAIN ST
Second Line :
City : BRADFORD
State : VT
Zip : 05033-9196
Country : US
Telephone Number : 802-222-9317
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2017
Last Update Date : 11/28/2022

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Directions to “ JAZMIN SMITH LICSW” Practice Location

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