MEDICARE: JERAD SMITH

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1215685573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERAD SMITH

Provider Business Mailing Address
First Line	:	491 CALVERT AVE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-2201
Country	:	US
Telephone Number	:	814-460-7602
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 CLAIRTON BLVD STE 600
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-5511
Country	:	US
Telephone Number	:	412-650-1100
Fax Number	:

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

Provider Enumeration Date	:	03/16/2022
Last Update Date	:	03/16/2022

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Directions to “ JERAD SMITH ” Practice Location

Language	Start Address	Practice Location

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