Provider Demographics
NPI:1033575485
Name:SMITH, MARY BARRETT (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BARRETT
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BARRETT
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:1260 DAUPHIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-2546
Mailing Address - Country:US
Mailing Address - Phone:251-554-2075
Mailing Address - Fax:
Practice Address - Street 1:1260 DAUPHIN ST STE 111
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-2546
Practice Address - Country:US
Practice Address - Phone:251-554-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPSW12901041C0700X
AL4092C-19121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical