MEDICARE: DANIELLE PEARL SMITH PCSW

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	LCSW-924	WY

General Provider Information

NPI Number	:	1356780522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE PEARL SMITH PCSW

Provider Business Mailing Address
First Line	:	800 WERNER CT STE 205B
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1326
Country	:	US
Telephone Number	:	307-277-6025
Fax Number	:	605-443-8880

Provider Business Practice Location Address
First Line	:	800 WERNER CT STE 205B
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601-1326
Country	:	US
Telephone Number	:	307-277-6025
Fax Number	:

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

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	10/22/2020

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