Provider Demographics
NPI:1275700593
Name:SMITH, LAVERNE (MSW)
Entity Type:Individual
Prefix:
First Name:LAVERNE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 ZOLLMAN CT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-2147
Mailing Address - Country:US
Mailing Address - Phone:972-218-7166
Mailing Address - Fax:
Practice Address - Street 1:8625 KING GEORGE DR STE 111
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-2240
Practice Address - Country:US
Practice Address - Phone:214-631-7002
Practice Address - Fax:214-631-6698
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker