Provider Demographics
NPI:1811136328
Name:SMITH, SANDRA MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15492 BLUE SKIES ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1518
Mailing Address - Country:US
Mailing Address - Phone:734-462-1954
Mailing Address - Fax:
Practice Address - Street 1:15492 BLUE SKIES ST
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1518
Practice Address - Country:US
Practice Address - Phone:173-446-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-08
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010818901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical