Provider Demographics
NPI:1790919686
Name:SMITH, JOAN B (LCSW)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:B
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 SOMERS DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8659
Mailing Address - Country:US
Mailing Address - Phone:410-546-1410
Mailing Address - Fax:
Practice Address - Street 1:6040 PUBLIC LANDING ROAD
Practice Address - Street 2:WORCESTER COUNTY HEALTH DEPARTMENT
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863
Practice Address - Country:US
Practice Address - Phone:410-632-1100
Practice Address - Fax:410-632-0906
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08292104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD705371101Medicaid
MDS013Medicare UPIN