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NPI Code Detail

MEDICARE: KELLY SANDRA SMITH LCSW-R

MEDICARE: KELLY SANDRA SMITH LCSW-R
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
11041C0700XClinical Social WorkerR054827-1NY
21041C0700XClinical Social Worker61469825WA
31041C0700XClinical Social Worker112157CA
41041C0700XClinical Social Worker0904016388VA

General Provider Information

NPI Number : 1861441297
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY SANDRA SMITH LCSW-R
Provider Business Mailing Address
First Line : 3411 DELAWARE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23222-2912
Country : US
Telephone Number : 804-845-1015
Fax Number :
Provider Business Practice Location Address
First Line : 3411 DELAWARE AVE
Second Line :
City : RICHMOND
State : VA
Zip : 23222-2912
Country : US
Telephone Number : 804-845-1015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 04/13/2026

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