Provider Demographics
NPI:1710602545
Name:SMITH, KENNETH ROBERT (MSW, BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ROBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW, BA PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5021 E TRINDLE RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-3528
Mailing Address - Country:US
Mailing Address - Phone:717-406-5190
Mailing Address - Fax:717-202-2590
Practice Address - Street 1:5021 E TRINDLE RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-3528
Practice Address - Country:US
Practice Address - Phone:717-406-5190
Practice Address - Fax:717-202-2590
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASW139803104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker