Provider Demographics
NPI:1457302846
Name:SMITH, MITCHELL SCOTT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:SCOTT
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-4327
Mailing Address - Country:US
Mailing Address - Phone:717-763-4353
Mailing Address - Fax:717-737-2732
Practice Address - Street 1:3812 MARKET ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-4327
Practice Address - Country:US
Practice Address - Phone:717-763-4353
Practice Address - Fax:717-737-2732
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000555L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR08243Medicare UPIN
PA648570Medicare ID - Type Unspecified