Provider Demographics
NPI:1538129770
Name:SMITH, KAREN MORKEL (LISW)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:MORKEL
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 1:605 S TRIMBLE RD
Mailing Address - Street 2:STE D
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906
Mailing Address - Country:US
Mailing Address - Phone:419-756-9975
Mailing Address - Fax:419-756-1405
Practice Address - Street 1:605 S TRIMBLE RD
Practice Address - Street 2:STE D
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906
Practice Address - Country:US
Practice Address - Phone:419-756-9975
Practice Address - Fax:419-756-1405
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH100018731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3417125562A11OtherMAGELLAN
OHSMSW11821Medicare ID - Type Unspecified