Provider Demographics
NPI:1700272630
Name:SMITH, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
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 1:3217 LAWNVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21213-1627
Mailing Address - Country:US
Mailing Address - Phone:443-629-2233
Mailing Address - Fax:443-320-9218
Practice Address - Street 1:3217 LAWNVIEW AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21213-1627
Practice Address - Country:US
Practice Address - Phone:443-629-2233
Practice Address - Fax:443-320-9218
Is Sole Proprietor?:No
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15799171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator