Provider Demographics
NPI:1235719097
Name:SMITH, CORINSA BEATRIZ
Entity Type:Individual
Prefix:
First Name:CORINSA
Middle Name:BEATRIZ
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 FREEDOM WAY APT 12
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-1074
Mailing Address - Country:US
Mailing Address - Phone:502-654-4822
Mailing Address - Fax:
Practice Address - Street 1:3810 FREEDOM WAY APT 12
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-1074
Practice Address - Country:US
Practice Address - Phone:150-265-4482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY263831101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty