Provider Demographics
NPI:1952372633
Name:GRAMER SMITHE, MARY JACQUELINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JACQUELINE
Last Name:GRAMER SMITHE
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 1:1020 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-3176
Mailing Address - Country:US
Mailing Address - Phone:801-539-7022
Mailing Address - Fax:
Practice Address - Street 1:1141 E 3900 S
Practice Address - Street 2:STE A250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1215
Practice Address - Country:US
Practice Address - Phone:801-539-7000
Practice Address - Fax:801-539-7050
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT266258-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT942938348GR2OtherEDUCATORS MUTUAL
UT186306OtherINTRMTN HEALTH CARE
UTS77687OtherMEDICARE ADVANTAGE PLANS
UT005739005OtherRAILROAD MEDICARE
UT262026OtherDESERET MUTUAL
UT942938348014Medicaid
UT942938348OtherCHAMPUS
UTS77687OtherMEDICARE ADVANTAGE PLANS
UT942938348OtherCHAMPUS
UT942938348014Medicaid
UTU000075203Medicare PIN