Provider Demographics
NPI:1518651223
Name:SMITH, NICOLE ANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANNA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TOWN SQUARE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-6535
Mailing Address - Country:US
Mailing Address - Phone:410-231-0488
Mailing Address - Fax:410-449-6171
Practice Address - Street 1:225 TOWN SQUARE DR STE 3
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-6535
Practice Address - Country:US
Practice Address - Phone:410-231-0488
Practice Address - Fax:410-449-6171
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD301331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical