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NPI Code Detail

MEDICARE: LINA SMITH LBSW, ADC

MEDICARE: LINA SMITH LBSW, ADC
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 WorkerLSW-28715ID
2101YA0400XAddiction (Substance Use Disorder) Counselor11540033ID

General Provider Information

NPI Number : 1588091235
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINA SMITH LBSW, ADC
Provider Business Mailing Address
First Line : 709 DEARBORN ST
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4116
Country : US
Telephone Number : 208-376-7083
Fax Number : 208-402-5604
Provider Business Practice Location Address
First Line : 709 DEARBORN ST
Second Line :
City : CALDWELL
State : ID
Zip : 83605-4116
Country : US
Telephone Number : 208-376-7083
Fax Number : 208-402-5604
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2013
Last Update Date : 07/02/2024

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