Provider Demographics
NPI:1538232988
Name:SMITHERS, MARY A (LCSW CASAC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:A
Last Name:SMITHERS
Suffix:
Gender:F
Credentials:LCSW CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 HIGHLY
Mailing Address - Street 2:
Mailing Address - City:ST JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506
Mailing Address - Country:US
Mailing Address - Phone:816-233-7555
Mailing Address - Fax:
Practice Address - Street 1:2404 HIGHLY
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506
Practice Address - Country:US
Practice Address - Phone:816-233-7555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001959104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker