1811457112 NPI number — MISS OLISHA CALVETTE SMITH MSW, LCSW

Table of content: MISS OLISHA CALVETTE SMITH MSW, LCSW (NPI 1811457112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811457112 NPI number — MISS OLISHA CALVETTE SMITH MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
OLISHA
Provider Middle Name:
CALVETTE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAFU
Provider Other First Name:
OLISHA
Provider Other Middle Name:
CALVETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811457112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7712 BOLERO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBY
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46113-8764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-315-1599
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 ESKENAZI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-5187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-880-7666
Provider Business Practice Location Address Fax Number:
317-880-0448
Provider Enumeration Date:
03/22/2019

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:  34008358A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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