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NPI Code Detail

MEDICARE: CHARLES OWEN SMITH LSW

MEDICARE:   CHARLES OWEN SMITH  LSW
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
1104100000XSocial WorkerSW142529PA

General Provider Information

NPI Number : 1508791872
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES OWEN SMITH LSW
Provider Business Mailing Address
First Line : 175 STRAFFORD AVE
Second Line :
City : WAYNE
State : PA
Zip : 19087-3317
Country : US
Telephone Number : 717-908-8905
Fax Number :
Provider Business Practice Location Address
First Line : 175 STRAFFORD AVE
Second Line :
City : WAYNE
State : PA
Zip : 19087-3317
Country : US
Telephone Number : 717-908-8905
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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Directions to “ CHARLES OWEN SMITH LSW” Practice Location

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