MEDICARE: AMY SMITH

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	1041S0200X	School Social Worker	SW123077	PA

General Provider Information

NPI Number	:	1598210502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY SMITH

Provider Business Mailing Address
First Line	:	588 ARNOLD DR
Second Line	:
City	:	JEFFERSON TWP
State	:	PA
Zip	:	18436-3255
Country	:	US
Telephone Number	:	570-689-5401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 LINE ST
Second Line	:
City	:	ARCHBALD
State	:	PA
Zip	:	18403-1918
Country	:	US
Telephone Number	:	570-876-9200
Fax Number	:

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

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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Directions to “ AMY SMITH ” Practice Location

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