Provider Demographics
NPI:1740457738
Name:SMITH, KATHY M (BA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2418
Mailing Address - Country:US
Mailing Address - Phone:610-566-7540
Mailing Address - Fax:610-566-7677
Practice Address - Street 1:600 N OLIVE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2418
Practice Address - Country:US
Practice Address - Phone:610-566-7540
Practice Address - Fax:610-566-7677
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker