Provider Demographics
NPI:1972661585
Name:SMITH, JUDITH A (MSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 WEST JAMES ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603
Mailing Address - Country:US
Mailing Address - Phone:717-397-4614
Mailing Address - Fax:717-397-3416
Practice Address - Street 1:630 JANET AVE
Practice Address - Street 2:FAMILY SERVICE
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601
Practice Address - Country:US
Practice Address - Phone:717-397-5241
Practice Address - Fax:717-397-2530
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW014397104100000X
MA106024104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
11575982OtherCAQH COUNTY FOR AFFORDABL
PA057978QK1Medicare ID - Type Unspecified
057978QK1Medicare UPIN