Provider Demographics
NPI:1164962031
Name:SMITH, DANIEL T (LISW, LICDC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 TUSCARAWAS ST E
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-3152
Mailing Address - Country:US
Mailing Address - Phone:330-205-9515
Mailing Address - Fax:330-754-6253
Practice Address - Street 1:901 TUSCARAWAS ST E
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-3152
Practice Address - Country:US
Practice Address - Phone:330-205-9515
Practice Address - Fax:330-754-6253
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.141762101YA0400X
OHLICDC162119101YA0400X
OHS.1904462104100000X
OHI.22041691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0375118Medicaid