MEDICARE: ROBERT ELIAS SMITH LMSW

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	6801095444	MI
2	1041C0700X	Clinical Social Worker	6801095444	MI

General Provider Information

NPI Number	:	1679816359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ELIAS SMITH LMSW

Provider Business Mailing Address
First Line	:	2215 OAK INDUSTRIAL DR NE STE 209
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6037
Country	:	US
Telephone Number	:	616-288-1556
Fax Number	:	616-288-1556

Provider Business Practice Location Address
First Line	:	2215 OAK INDUSTRIAL DR NE STE 209
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49505-6037
Country	:	US
Telephone Number	:	616-288-1556
Fax Number	:	616-288-1556

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

Provider Enumeration Date	:	04/01/2013
Last Update Date	:	12/03/2025

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