MEDICARE: DR. DIANE T SMITH DSW, LISW-S, LICDC

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	101YM0800X	Mental Health Counselor	I-1303643	OH

General Provider Information

NPI Number	:	1659708428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANE T SMITH DSW, LISW-S, LICDC

Provider Business Mailing Address
First Line	:	2020 W SCHAAF RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-4608
Country	:	US
Telephone Number	:	216-202-5118
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 W SCHAAF RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-4608
Country	:	US
Telephone Number	:	216-202-5118
Fax Number	:

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

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	04/22/2024

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