MEDICARE: KANDI ANN SMITH-MARLOW LICSW, CCM

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	097.0127079	VT

General Provider Information

NPI Number	:	1619492790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDI ANN SMITH-MARLOW LICSW, CCM

Provider Business Mailing Address
First Line	:	13 S MAIN ST
Second Line	:
City	:	JERICHO
State	:	VT
Zip	:	05465-2555
Country	:	US
Telephone Number	:	802-598-1729
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 MAPLE STREET PLACE
Second Line	:
City	:	WILLISTON
State	:	VT
Zip	:	05495-2555
Country	:	US
Telephone Number	:	802-316-8444
Fax Number	:

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

Provider Enumeration Date	:	08/09/2017
Last Update Date	:	02/06/2024

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