Provider Demographics
NPI:1316792674
Name:SMITH, CAMRYN AMELIA (LSW)
Entity type:Individual
Prefix:
First Name:CAMRYN
Middle Name:AMELIA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29228 REGENCY CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-6701
Mailing Address - Country:US
Mailing Address - Phone:216-213-2503
Mailing Address - Fax:
Practice Address - Street 1:3500 LORAIN AVE STE 407
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3726
Practice Address - Country:US
Practice Address - Phone:216-250-1607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.2309316104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker