Provider Demographics
NPI:1487634382
Name:SMITH, SUSAN M (LMHP LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMHP LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10824 OLD MILL RD
Mailing Address - Street 2:STE 21
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2642
Mailing Address - Country:US
Mailing Address - Phone:402-330-6060
Mailing Address - Fax:402-330-6108
Practice Address - Street 1:10824 OLD MILL RD
Practice Address - Street 2:STE 21
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2642
Practice Address - Country:US
Practice Address - Phone:402-330-6060
Practice Address - Fax:402-330-6108
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17101YP2500X
NE6261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE82368OtherBLUE CROSS BLUE SHIELD
267941Medicare ID - Type Unspecified
R81509Medicare UPIN