Provider Demographics
NPI:1811690415
Name:SMITH, KEANN
Entity type:Individual
Prefix:
First Name:KEANN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3146 16TH ST NW APT 313
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3391
Mailing Address - Country:US
Mailing Address - Phone:202-210-8499
Mailing Address - Fax:
Practice Address - Street 1:3146 16TH ST NW APT 313
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3391
Practice Address - Country:US
Practice Address - Phone:202-210-8499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician