Provider Demographics
NPI:1033185384
Name:SMITH, ANN D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7331
Mailing Address - Country:US
Mailing Address - Phone:570-655-4846
Mailing Address - Fax:
Practice Address - Street 1:230 WYOMING AVE
Practice Address - Street 2:COUNSELING AND LEARNING ASSOCIATES
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3535
Practice Address - Country:US
Practice Address - Phone:570-288-5168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW001949L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA801939OtherFIRST PRIORITY HEALTH
PASM701066OtherHIGHMARK BLUE SHIELD