Provider Demographics
NPI:1790120996
Name:SMITH, PATRICIA R (LISW-S)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5642 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-3114
Mailing Address - Country:US
Mailing Address - Phone:513-636-0800
Mailing Address - Fax:
Practice Address - Street 1:1165 EATON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1402
Practice Address - Country:US
Practice Address - Phone:513-868-7700
Practice Address - Fax:513-896-3600
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1200487-SUPV104100000X
OHI-12004871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical