Provider Demographics
NPI:1790095545
Name:SMITH, JENNIFER (BA PSYCH)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SMITH
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Gender:F
Credentials:BA PSYCH
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Mailing Address - Street 1:REAR 307 LAIRD STREET
Mailing Address - Street 2:CHOICES PROGRAM OF WYOMING VALLEY
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702
Mailing Address - Country:US
Mailing Address - Phone:570-408-9320
Mailing Address - Fax:570-408-9324
Practice Address - Street 1:REAR 307 LAIRD STREET
Practice Address - Street 2:CHOICES PROGRAM OF WYOMING VALLEY
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702
Practice Address - Country:US
Practice Address - Phone:570-408-9320
Practice Address - Fax:570-408-9324
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)