MEDICARE: DARYL SMITH LICSW

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	1041C0700X	Clinical Social Worker	24865	MN

General Provider Information

NPI Number	:	1871018192
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARYL SMITH LICSW

Provider Business Mailing Address
First Line	:	308 4TH AVE NW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-3140
Country	:	US
Telephone Number	:	507-438-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 4TH AVE NW
Second Line	:
City	:	AUSTIN
State	:	MN
Zip	:	55912-3140
Country	:	US
Telephone Number	:	507-438-4026
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	02/02/2023

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