1710033691 NPI number — KATHLEEN P SMITH LCSW

Table of content: KATHLEEN P SMITH LCSW (NPI 1710033691)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710033691 NPI number — KATHLEEN P SMITH LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
KATHLEEN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710033691
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CHADBOURNE RD FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94534-9645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-439-4039
Provider Business Mailing Address Fax Number:
402-439-4035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CHADBOURNE RD FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94534-9645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-439-4039
Provider Business Practice Location Address Fax Number:
402-439-4035
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  542 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 90563 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 542 . This is a "CMSW" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 90563 . This is a "LCSW" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 646 . This is a "LMHP" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".