Provider Demographics
NPI:1275809949
Name:SMITH, CAREN K (MA, LLP)
Entity Type:Individual
Prefix:
First Name:CAREN
Middle Name:K
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LLP
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:K
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLP
Mailing Address - Street 1:2075 W BIG BEAVER RD STE 520
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3442
Mailing Address - Country:US
Mailing Address - Phone:248-646-6659
Mailing Address - Fax:
Practice Address - Street 1:2075 W BIG BEAVER RD STE 520
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3442
Practice Address - Country:US
Practice Address - Phone:248-646-6659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012104101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health