Provider Demographics
NPI:1083734107
Name:SMIT, CINDY LEE (MSW)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LEE
Last Name:SMIT
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:LEE
Other - Last Name:ANDERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:2028 E 38TH ST
Mailing Address - Street 2:STE 3
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1168
Mailing Address - Country:US
Mailing Address - Phone:563-424-2016
Mailing Address - Fax:563-424-2017
Practice Address - Street 1:2028 E 38TH ST
Practice Address - Street 2:STE 3
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1168
Practice Address - Country:US
Practice Address - Phone:563-424-2016
Practice Address - Fax:563-424-2017
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0076271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
074520025Medicare PIN