Provider Demographics
NPI:1790360006
Name:SMITH, CATHERINE IRENE (NBC-HWC)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:IRENE
Last Name:SMITH
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:MRS
Other - First Name:KASIA
Other - Middle Name:IRENE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NBC-HWC
Mailing Address - Street 1:9901 BRODIE LN STE 160
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-5892
Mailing Address - Country:US
Mailing Address - Phone:860-384-3627
Mailing Address - Fax:
Practice Address - Street 1:9901 BRODIE LN STE 160
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-5892
Practice Address - Country:US
Practice Address - Phone:860-384-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTA3138594174H00000X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No174H00000XOther Service ProvidersHealth Educator