Provider Demographics
NPI:1497731558
Name:SMITH, GAIL MELINDA (LISW)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:MELINDA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 STONEY RUN TRL
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2560
Mailing Address - Country:US
Mailing Address - Phone:440-546-0608
Mailing Address - Fax:440-846-0890
Practice Address - Street 1:14843 W SPRAGUE RD
Practice Address - Street 2:SUITE A
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6601
Practice Address - Country:US
Practice Address - Phone:440-234-9955
Practice Address - Fax:440-234-5994
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100071041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical