Basic Information
| Provider Information | |||||||||
| NPI: | 1023257573 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | SEAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LSW, LICDC-CS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 CURRY LN | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451501893 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133688324 | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 WHITNEY DR STE 122 | ||||||||
| Address2: | |||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451508400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139414999 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2009 | ||||||||
| LastUpdateDate: | 07/30/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | S1100423 | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | 011119 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.