Provider Demographics
NPI:1184643280
Name:SMITH, ABBEE DALLEK (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ABBEE
Middle Name:DALLEK
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 N DIXIE WAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-3385
Mailing Address - Country:US
Mailing Address - Phone:574-234-3515
Mailing Address - Fax:574-234-3565
Practice Address - Street 1:227 N DIXIE WAY
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-3385
Practice Address - Country:US
Practice Address - Phone:574-234-3515
Practice Address - Fax:574-234-3565
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000672A1041C0700X
MI68010747511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200375890AMedicaid
IN218430AMedicare ID - Type UnspecifiedSOCIAL WORK PROVIDER