Provider Demographics
NPI:1396084950
Name:SMITH, LA MONTE (MSW)
Entity type:Individual
Prefix:
First Name:LA MONTE
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4276 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53216-1117
Mailing Address - Country:US
Mailing Address - Phone:414-393-4832
Mailing Address - Fax:414-393-4815
Practice Address - Street 1:4920 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53216-2321
Practice Address - Country:US
Practice Address - Phone:414-393-4832
Practice Address - Fax:414-393-4815
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical