Provider Demographics
NPI:1730846890
Name:JENNIFER SMAK, LMSW LLC
Entity type:Organization
Organization Name:JENNIFER SMAK, LMSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:248-520-2976
Mailing Address - Street 1:521 KIRTS BLVD APT 45
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-5277
Mailing Address - Country:US
Mailing Address - Phone:248-520-2976
Mailing Address - Fax:
Practice Address - Street 1:16291 W 14 MILE RD STE 5
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-3327
Practice Address - Country:US
Practice Address - Phone:248-520-2976
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health