Provider Demographics
NPI:1821168246
Name:SMITH, GWENDOLYN G (ACSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:G
Last Name:SMITH
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7057 BROWN DERBY CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-3424
Mailing Address - Country:US
Mailing Address - Phone:702-254-8466
Mailing Address - Fax:
Practice Address - Street 1:4538 WEST CRAIG ROAD
Practice Address - Street 2:SUITE 290
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032
Practice Address - Country:US
Practice Address - Phone:702-486-5610
Practice Address - Fax:702-486-5630
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01029-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical