Provider Demographics
NPI:1295806594
Name:SMITH, JAN IRIS (LCSW,BCD)
Entity type:Individual
Prefix:MS
First Name:JAN
Middle Name:IRIS
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 78TH ST
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-1309
Mailing Address - Country:US
Mailing Address - Phone:301-320-4825
Mailing Address - Fax:
Practice Address - Street 1:6502 78TH ST
Practice Address - Street 2:
Practice Address - City:CABIN JOHN
Practice Address - State:MD
Practice Address - Zip Code:20818-1309
Practice Address - Country:US
Practice Address - Phone:301-320-4825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD051821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical