Provider Demographics
NPI:1942848866
Name:SMITH, TAYLOR-MARIE
Entity Type:Individual
Prefix:
First Name:TAYLOR-MARIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLOR-MARIE
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TAYLOR-MARIE SMITH
Mailing Address - Street 1:3735 NORTHAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44121-2026
Mailing Address - Country:US
Mailing Address - Phone:216-820-8903
Mailing Address - Fax:
Practice Address - Street 1:2037 W 32ND ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4017
Practice Address - Country:US
Practice Address - Phone:216-651-5982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.19044971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical