Provider Demographics
NPI:1891023743
Name:SMOOT, SHARILYN RAE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHARILYN
Middle Name:RAE
Last Name:SMOOT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17940 BOWIE MILL RD
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1611
Mailing Address - Country:US
Mailing Address - Phone:240-778-3122
Mailing Address - Fax:
Practice Address - Street 1:17940 BOWIE MILL RD
Practice Address - Street 2:
Practice Address - City:DERWOOD
Practice Address - State:MD
Practice Address - Zip Code:20855-1611
Practice Address - Country:US
Practice Address - Phone:240-778-3122
Practice Address - Fax:240-778-3122
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical