Provider Demographics
NPI:1457966137
Name:SMITH, EMILY MAE (LISW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:MAE
Other - Last Name:PATTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:16 MEADOW DR APT 23
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2858
Mailing Address - Country:US
Mailing Address - Phone:216-630-0576
Mailing Address - Fax:
Practice Address - Street 1:777 COLUMBUS AVE # 7-D
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1684
Practice Address - Country:US
Practice Address - Phone:513-228-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-10
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.23045941041C0700X
OHS.2004867104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker