MEDICARE: KAMILAH 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1689147506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMILAH SMITH

Provider Business Mailing Address
First Line	:	1355 E 99TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 EASTERN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11233-4804
Country	:	US
Telephone Number	:	718-255-5946
Fax Number	:

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

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/03/2019

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Directions to “ KAMILAH SMITH ” Practice Location

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