Provider Demographics
NPI:1972871549
Name:SMITH, JENETTE BONGIORNO (LMSW)
Entity type:Individual
Prefix:
First Name:JENETTE
Middle Name:BONGIORNO
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 S LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5483
Mailing Address - Country:US
Mailing Address - Phone:810-720-2913
Mailing Address - Fax:810-720-3296
Practice Address - Street 1:2360 S LINDEN RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5483
Practice Address - Country:US
Practice Address - Phone:810-720-2913
Practice Address - Fax:810-720-3296
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010905971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical