Provider Demographics
NPI:1790287480
Name:SMITH, DE'RON (OWDS, CCME, CDCA,)
Entity Type:Individual
Prefix:MR
First Name:DE'RON
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:OWDS, CCME, CDCA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-6107
Mailing Address - Country:US
Mailing Address - Phone:513-242-7600
Mailing Address - Fax:
Practice Address - Street 1:4721 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-6107
Practice Address - Country:US
Practice Address - Phone:513-242-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator