MEDICARE: MRS. MEARA SMITH LMFT

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	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1346676657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEARA SMITH LMFT

Provider Business Mailing Address
First Line	:	3904 N WOLCOTT AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2433
Country	:	US
Telephone Number	:	909-528-4943
Fax Number	:

Provider Business Practice Location Address
First Line	:	3904 N WOLCOTT AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-2433
Country	:	US
Telephone Number	:	909-528-4943
Fax Number	:

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

Provider Enumeration Date	:	09/18/2013
Last Update Date	:	03/11/2021

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