MEDICARE: TIFFANY RENEE SMITH LCSW-C

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1427128248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY RENEE SMITH LCSW-C

Provider Business Mailing Address
First Line	:	3218 NORTHWAY DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-7827
Country	:	US
Telephone Number	:	410-426-0386
Fax Number	:

Provider Business Practice Location Address
First Line	:	3218 NORTHWAY DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21234-7827
Country	:	US
Telephone Number	:	410-426-0386
Fax Number	:

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

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/17/2016

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