1427355031 NPI number — SUSAN BENNETT SMITH LICSW, PIP

Table of content: SUSAN BENNETT SMITH LICSW, PIP (NPI 1427355031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427355031 NPI number — SUSAN BENNETT SMITH LICSW, PIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
SUSAN
Provider Middle Name:
BENNETT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW, PIP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SMITH
Provider Other First Name:
SUSAN
Provider Other Middle Name:
BENNETT
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW, PIP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427355031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2138 CHALYBE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35226-6255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-566-6560
Provider Business Mailing Address Fax Number:
205-638-5037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2138 CHALYBE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35226-6255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-566-6560
Provider Business Practice Location Address Fax Number:
205-638-5037
Provider Enumeration Date:
02/16/2011

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: 1041C0700X , with the licence number:  1605C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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