Provider Demographics
NPI:1669053658
Name:SMART, WANDA LENORE (LISW-S)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:LENORE
Last Name:SMART
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3784 E 153RD ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-1110
Mailing Address - Country:US
Mailing Address - Phone:216-225-2636
Mailing Address - Fax:
Practice Address - Street 1:2554 W 25TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-4700
Practice Address - Country:US
Practice Address - Phone:216-781-2250
Practice Address - Fax:216-781-2252
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.00085981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical