Provider Demographics
NPI:1619492790
Name:SMITH-MARLOW, KANDI ANN (LICSW, CCM)
Entity Type:Individual
Prefix:
First Name:KANDI
Middle Name:ANN
Last Name:SMITH-MARLOW
Suffix:
Gender:F
Credentials:LICSW, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-2555
Mailing Address - Country:US
Mailing Address - Phone:802-598-1729
Mailing Address - Fax:
Practice Address - Street 1:1375 MAPLE STREET PLACE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-2555
Practice Address - Country:US
Practice Address - Phone:802-316-8444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT097.0127079104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker