MEDICARE: CHASSITY ANNETTE 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	4482C	AL

General Provider Information

NPI Number	:	1205441060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASSITY ANNETTE SMITH LICSW

Provider Business Mailing Address
First Line	:	5504 PARK SIDE CIR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-5123
Country	:	US
Telephone Number	:	205-531-4932
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 E LAKE BLVD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35217-3545
Country	:	US
Telephone Number	:	205-531-4932
Fax Number	:

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

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	09/09/2020

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Directions to “ CHASSITY ANNETTE SMITH LICSW” Practice Location

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