Provider Demographics
NPI:1326823758
Name:SMITH, TABITHA MICHELLE (MSW)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:MICHELLE
Other - Last Name:BOCKRATH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:1500 N FRANKLIN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-3140
Mailing Address - Country:US
Mailing Address - Phone:615-653-1951
Mailing Address - Fax:
Practice Address - Street 1:256 CHAPMAN RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5499
Practice Address - Country:US
Practice Address - Phone:302-292-1334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE104100000X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker