Provider Demographics
NPI:1780782250
Name:SMITH, CAROL M (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-2009
Mailing Address - Country:US
Mailing Address - Phone:856-235-6308
Mailing Address - Fax:609-386-8674
Practice Address - Street 1:770 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3073
Practice Address - Country:US
Practice Address - Phone:856-234-7422
Practice Address - Fax:609-386-8674
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000375001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0506280000OtherAMERIHEALTH
NJ0506280000OtherINDEPENDENCE BLUE CROSS
NJ4559692OtherAETNA