Provider Demographics
NPI:1417372319
Name:SMITH, MARCEY MAE (LICSW)
Entity Type:Individual
Prefix:
First Name:MARCEY
Middle Name:MAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 E FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-2923
Mailing Address - Country:US
Mailing Address - Phone:612-872-8086
Mailing Address - Fax:612-238-0399
Practice Address - Street 1:1213 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-2923
Practice Address - Country:US
Practice Address - Phone:612-872-8086
Practice Address - Fax:612-238-0399
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN229641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical