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NPI Code Detail

MEDICARE: CARLY SMITH

MEDICARE: CARLY 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
1101YM0800XMental Health Counselor
2101Y00000XCounselor
3171M00000XCase Manager/Care Coordinator
41041C0700XClinical Social Worker
5390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1811571599
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLY SMITH
Provider Business Mailing Address
First Line : 28 STATE ST STE 5
Second Line :
City : GORHAM
State : ME
Zip : 04038-1147
Country : US
Telephone Number : 207-222-0299
Fax Number :
Provider Business Practice Location Address
First Line : 28 STATE ST STE 5
Second Line :
City : GORHAM
State : ME
Zip : 04038-1147
Country : US
Telephone Number : 207-222-0299
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2021
Last Update Date : 02/02/2026

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Directions to “ CARLY SMITH ” Practice Location

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