Staci Smith, LISW-S

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I.1500936-SUPV Issued in OH

Practice address

775 Lexington Ave
Mansfield, OH 44907-1906

Phone

(419) 774-4010

Fax

(417) 774-4014

NPI assigned

Feb 9, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Staci Shaw Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1423440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778544000000",
    "number": "1255722500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78 MAYFAIR RD",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449049781",
            "telephone_number": "260-668-6404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 LEXINGTON AVE",
            "city": "MANSFIELD",
            "state": "OH",
            "postal_code": "449071906",
            "telephone_number": "419-774-4010",
            "fax_number": "417-774-4014"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Graham Dr",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "OH",
            "postal_code": "457011430",
            "country_code": "US",
            "telephone_number": "800-321-8293",
            "fax_number": "800-321-8293",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3591 Reserve Commons Dr Ste 301",
            "address_purpose": "LOCATION",
            "city": "Medina",
            "state": "OH",
            "postal_code": "442565334",
            "country_code": "US",
            "telephone_number": "330-764-7916",
            "fax_number": "419-756-5642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STACI",
        "credential": "LISW-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-02-09",
        "last_updated": "2026-05-12",
        "certification_date": "2026-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.1500936-SUPV",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "S.1201024",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACI",
            "last_name": "SHAW",
            "credential": "LISW-S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• La Rue Smith
• Leighana Nichole Smith, LPN
• Megan Smith, DPT
• Rachel Smith, RPH
• Rakaysha Ladaysha Smith
• Stefanie Smith
• Tina Marie Smith, LPN
• Trinity Smith
• Amber Marie Smoot
• George A Snicer, MD

• Clinical Social Worker in Mansfield, OH
• Providers in Mansfield, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.