Provider Demographics
NPI:1306173737
Name:SMITH, ENRICA T (LMFT/LCSW)
Entity type:Individual
Prefix:
First Name:ENRICA
Middle Name:T
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMFT/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:HILLVIEW
Mailing Address - State:KY
Mailing Address - Zip Code:40129-0664
Mailing Address - Country:US
Mailing Address - Phone:502-200-4992
Mailing Address - Fax:888-972-4081
Practice Address - Street 1:1500 ENVOY CIR STE 1520
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2898
Practice Address - Country:US
Practice Address - Phone:502-200-4992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0839106H00000X
IN35001941A106H00000X
TX204109106H00000X
KY105238106H00000X
KY2526971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100299920Medicaid