Provider Demographics
NPI:1598712747
Name:SMITH, LAURA ROBIN (LCSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ROBIN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 BISHOP LN STE 1019
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1928
Mailing Address - Country:US
Mailing Address - Phone:502-851-6384
Mailing Address - Fax:
Practice Address - Street 1:1941 BISHOP LN STE 1019
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1928
Practice Address - Country:US
Practice Address - Phone:502-851-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100041990Medicaid
KYP00143400OtherRR MEDICARE
KY00546160Medicare Oscar/Certification
KYP00143400OtherRR MEDICARE