Provider Demographics
NPI:1336191766
Name:SMITH, ELIZABETH ROSS (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSS
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 RACHELS RETREAT CIR
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2870
Mailing Address - Country:US
Mailing Address - Phone:615-883-0740
Mailing Address - Fax:615-883-0740
Practice Address - Street 1:2526 N MOUNT JULIET RD
Practice Address - Street 2:
Practice Address - City:MOUNT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3007
Practice Address - Country:US
Practice Address - Phone:615-557-5607
Practice Address - Fax:615-883-0740
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000031151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN30068238OtherBLUE CROSS BLUE SHEILD
TN30068238OtherBLUE CROSS BLUE SHEILD