Provider Demographics
NPI:1871639047
Name:SMITH, SUSAN A (LISW)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E MARKET ST.
Mailing Address - Street 2:CO VALLEY COUNSELING SERVICES
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44481-1141
Mailing Address - Country:US
Mailing Address - Phone:330-399-6451
Mailing Address - Fax:330-394-6266
Practice Address - Street 1:150 E MARKET ST
Practice Address - Street 2:CO VALLEY COUNSELING SERVICES
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481
Practice Address - Country:US
Practice Address - Phone:330-399-6451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI3270104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW34701Medicare PIN