Provider Demographics
NPI:1922093566
Name:SMETANA MCHUGH, CHERYL K (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:K
Last Name:SMETANA MCHUGH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 12TH ST NW
Mailing Address - Street 2:
Mailing Address - City:PINE CITY
Mailing Address - State:MN
Mailing Address - Zip Code:55063-1186
Mailing Address - Country:US
Mailing Address - Phone:320-629-5352
Mailing Address - Fax:
Practice Address - Street 1:220 RAILROAD ST SE
Practice Address - Street 2:
Practice Address - City:PINE CITY
Practice Address - State:MN
Practice Address - Zip Code:55063-1540
Practice Address - Country:US
Practice Address - Phone:320-629-7600
Practice Address - Fax:320-629-7900
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN05829104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN62825500Medicaid
MN173137OtherUCARE MN
MN223J45MOtherBCBS
HP37569OtherHEALTH PARTNERS
MN1032827OtherBEHAVIORAL HEALTHCARE PRO
MN6253102OtherUNITED BEHAVIORAL HEALTH