Provider Demographics
NPI:1023395241
Name:SMITH, ROGER KENNETH (MDIV)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:KENNETH
Last Name:SMITH
Suffix:
Gender:M
Credentials:MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 SUNWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-7118
Mailing Address - Country:US
Mailing Address - Phone:717-381-5785
Mailing Address - Fax:
Practice Address - Street 1:835 HOUSTON RUN DR
Practice Address - Street 2:
Practice Address - City:GAP
Practice Address - State:PA
Practice Address - Zip Code:17527-9489
Practice Address - Country:US
Practice Address - Phone:717-442-9577
Practice Address - Fax:717-442-9672
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional