Provider Demographics
NPI:1376027581
Name:SMITH, ESTHERLENE DENISE (MS ED, LPC, CSW)
Entity type:Individual
Prefix:MRS
First Name:ESTHERLENE
Middle Name:DENISE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS ED, LPC, CSW
Other - Prefix:MRS
Other - First Name:ESTHERLENE
Other - Middle Name:DENISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS ED, LPC, CSW
Mailing Address - Street 1:151 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1456
Mailing Address - Country:US
Mailing Address - Phone:414-539-4915
Mailing Address - Fax:414-539-4914
Practice Address - Street 1:151 S 84TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-1456
Practice Address - Country:US
Practice Address - Phone:414-539-4915
Practice Address - Fax:141-539-4914
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6698-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional