Provider Demographics
NPI:1376707497
Name:SMITH, NIEAL MARIE (MA)
Entity Type:Individual
Prefix:MISS
First Name:NIEAL
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 N WINTHROP AVE APT 414
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1494
Mailing Address - Country:US
Mailing Address - Phone:773-398-0325
Mailing Address - Fax:
Practice Address - Street 1:5525 N WINTHROP AVE APT 414
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1494
Practice Address - Country:US
Practice Address - Phone:773-398-0325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150011540104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker