Provider Demographics
NPI:1164882684
Name:SMITH, CAROLIN (LMSW)
Entity Type:Individual
Prefix:
First Name:CAROLIN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5555 FREDERICKSBURG RD
Mailing Address - Street 2:#102
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3500
Mailing Address - Country:US
Mailing Address - Phone:210-616-0828
Mailing Address - Fax:855-616-0829
Practice Address - Street 1:5555 FREDERICKSBURG RD
Practice Address - Street 2:#102
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3500
Practice Address - Country:US
Practice Address - Phone:210-616-0828
Practice Address - Fax:855-616-0829
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX618301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical