Provider Demographics
NPI:1194952093
Name:SMITH, CARLA N (MSW, LSW, LCDC III)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:N
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSW, LSW, LCDC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 W 3RD ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1512
Mailing Address - Country:US
Mailing Address - Phone:216-443-8250
Mailing Address - Fax:216-443-8272
Practice Address - Street 1:1276 W 3RD ST STE 210
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113
Practice Address - Country:US
Practice Address - Phone:216-443-8250
Practice Address - Fax:216-443-8272
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0030938104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid