Provider Demographics
NPI:1033346796
Name:SMUTAK, STEPHEN A (MSSA, LSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:A
Last Name:SMUTAK
Suffix:
Gender:M
Credentials:MSSA, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 EASTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017-2045
Mailing Address - Country:US
Mailing Address - Phone:440-521-5087
Mailing Address - Fax:
Practice Address - Street 1:23792 LORAIN RD
Practice Address - Street 2:100
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2225
Practice Address - Country:US
Practice Address - Phone:440-734-4037
Practice Address - Fax:440-734-4710
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.00249791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical