Provider Demographics
NPI:1467940692
Name:SMITH, STEPHANIE JOYCE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOYCE
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 N RIDGE RD E STE E
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44055-3360
Mailing Address - Country:US
Mailing Address - Phone:440-324-5701
Mailing Address - Fax:440-277-0549
Practice Address - Street 1:1865 N RIDGE RD E STE E
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3360
Practice Address - Country:US
Practice Address - Phone:440-324-5701
Practice Address - Fax:440-277-0549
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHS.1900938-TRNE104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty