Individual provider Active NPI

Abbee Dallek Smith, LCSW

  • Clinical Social Worker
  • South Bend, IN
National Provider Identifier
1184643280
Registry record updated Feb 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34000672A Issued in IN
Practice address
227 N Dixie Way
South Bend, IN 46637-3385
Phone
(574) 234-3515
Fax
(574) 234-3565
NPI assigned
Jul 19, 2006
Last updated
Feb 17, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 34000672A IN Primary
Clinical Social Worker 1041C0700X 6801074751 MI

Addresses

Primary practice location

227 N Dixie Way
South Bend, IN 46637-3385

Mailing address

227 N Dixie Way
South Bend, IN 46637-3385
Phone (574) 234-3515

Other identifiers 1

IdentifierTypeStateIssuer
200375890AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040610001529 IN Practitioner - Clinical Social Worker 4385532431

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34000672AINMDClinical Social Worker
6801074751MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Family & Children's Center of Counseling and Development Services Inc Clinical PastSince Apr 30, 2003 Accepting new patients
Intrigue Counseling Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392595200000",
    "number": "1184643280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 N DIXIE WAY",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466373385",
            "telephone_number": "574-234-3515",
            "fax_number": "574-234-3565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 N DIXIE WAY",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466373385",
            "telephone_number": "574-234-3515",
            "fax_number": "574-234-3565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "ABBEE",
        "middle_name": "DALLEK",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2014-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34000672A",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801074751",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200375890A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

Verify at the official NPI Registry.