MEDICARE: CHELSEA ELIZABETH SMITH LSW

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	S.1701474	OH

General Provider Information

NPI Number	:	1972093524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA ELIZABETH SMITH LSW

Provider Business Mailing Address
First Line	:	100 ELMWOOD PARK DR
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	937-384-0580
Fax Number	:	937-384-0581

Provider Business Practice Location Address
First Line	:	100 ELMWOOD PARK DR
Second Line	:
City	:	WEST CARROLLTON
State	:	OH
Zip	:	45449-5402
Country	:	US
Telephone Number	:	937-384-0580
Fax Number	:	937-384-0581

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

Provider Enumeration Date	:	05/18/2018
Last Update Date	:	05/18/2018

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