Provider Demographics
NPI:1851179048
Name:SMITH-HANKE, KRISTA SAMANTHA (MSS, LSW)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:SAMANTHA
Last Name:SMITH-HANKE
Suffix:
Gender:F
Credentials:MSS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 CHESTER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4476
Mailing Address - Country:US
Mailing Address - Phone:301-832-8365
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST STE 3032
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3313
Practice Address - Country:US
Practice Address - Phone:215-573-2517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140626104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker