Provider Demographics
NPI:1346469491
Name:SMITH, SUSAN RENEE (MED, PC)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RENEE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MED, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 BROTHERTON RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1504
Mailing Address - Country:US
Mailing Address - Phone:513-752-1555
Mailing Address - Fax:513-688-8155
Practice Address - Street 1:551 BATAVIA PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-1518
Practice Address - Country:US
Practice Address - Phone:513-752-1555
Practice Address - Fax:513-688-8155
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC8309101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC8309OtherPROFESSIONAL COUNSELOR