Provider Demographics
NPI:1659708428
Name:SMITH, DIANE T (DSW, LISW-S, LICDC)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:DSW, LISW-S, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W SCHAAF RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-4608
Mailing Address - Country:US
Mailing Address - Phone:216-202-5118
Mailing Address - Fax:
Practice Address - Street 1:2020 W SCHAAF RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-4608
Practice Address - Country:US
Practice Address - Phone:216-202-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-10
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-1303643101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182016Medicaid