Provider Demographics
NPI:1457471328
Name:SMART, SUZANNE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:
Last Name:SMART
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 N PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-8891
Mailing Address - Country:US
Mailing Address - Phone:405-810-8230
Mailing Address - Fax:
Practice Address - Street 1:5015 N PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8891
Practice Address - Country:US
Practice Address - Phone:405-810-8230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical