Provider Demographics
NPI:1104228196
Name:SMITH, KRISTEN (SW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 COLONIAL VILLAGE LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6745
Mailing Address - Country:US
Mailing Address - Phone:717-391-0172
Mailing Address - Fax:717-391-7771
Practice Address - Street 1:1808 COLONIAL VILLAGE LN
Practice Address - Street 2:SUITE 103
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6745
Practice Address - Country:US
Practice Address - Phone:717-391-0172
Practice Address - Fax:717-391-7771
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW131695104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker