Provider Demographics
NPI:1750460333
Name:SMITH-PUTMAN, SARAH ANN (LC-ADC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANN
Last Name:SMITH-PUTMAN
Suffix:
Gender:F
Credentials:LC-ADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 206
Mailing Address - Street 2:
Mailing Address - City:CRUMPTON
Mailing Address - State:MD
Mailing Address - Zip Code:21628-0206
Mailing Address - Country:US
Mailing Address - Phone:443-994-9582
Mailing Address - Fax:
Practice Address - Street 1:860 HIGH ST
Practice Address - Street 2:
Practice Address - City:CHESTERTOWN
Practice Address - State:MD
Practice Address - Zip Code:21620-3909
Practice Address - Country:US
Practice Address - Phone:443-994-9582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA208101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD648429-01OtherBLUE CROSS BLUE SHIELD MD
MD100079084OtherAMERICAN PSYCH SYSTEMS
MD2144062OtherMAMSI/UNITED HEALTHCARE
MD206966OtherJOHNS HOPKINS HEALTHCARE
MDT418-0014OtherBCBS/GHMSI