Individual provider Active NPI

Sydni Smith

  • Clinical Social Worker
  • Oregon, OH
National Provider Identifier
1275091910
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
I.2405464 Issued in OH
Practice address
3140 Dustin Rd Ste 1
Oregon, OH 43616-4341
Phone
(567) 218-0185
Fax
(419) 930-6721
NPI assigned
Mar 12, 2019
Last updated
Jul 16, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X I.2405464 OH
Clinical Social Worker 1041C0700X I.2405464 OH Primary

Addresses

Primary practice location

3140 Dustin Rd Ste 1
Oregon, OH 43616-4341

Mailing address

615 Kingsbury St
Maumee, OH 43537-1865
Phone (567) 218-0185

Other practice location 1

615 Kingsbury St
Maumee, OH 43537-1865
Phone (567) 218-0185

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • 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
I20240925002994 OH Practitioner - Clinical Social Worker 6507307980 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
I.2405464OHMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Vaitkus Psychological Services LLC CurrentSince Jun 9, 2024 Accepting new patients
Drescher and Associates Clinical Services, LLC CurrentSince Aug 2, 2024 Accepting new patients

Locations

615 Kingsbury St
Maumee, OH 43537
Phone (419) 270-2490

3140 Dustin Rd
Ste 1
Oregon, OH 43616
Phone (567) 218-0185

1090 W South Boundary St
Ste 550
Perrysburg, OH 43551
Phone (567) 218-0185

Organizations & group practices 2

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": "1552348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1275091910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 KINGSBURY ST",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371865",
            "telephone_number": "567-218-0185",
            "fax_number": "419-930-6721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3140 DUSTIN RD STE 1",
            "city": "OREGON",
            "state": "OH",
            "postal_code": "436164341",
            "telephone_number": "567-218-0185",
            "fax_number": "419-930-6721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "615 Kingsbury St",
            "address_purpose": "LOCATION",
            "city": "Maumee",
            "state": "OH",
            "postal_code": "435371865",
            "country_code": "US",
            "telephone_number": "567-218-0185",
            "fax_number": "419-930-6721",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SYDNI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-12",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "I.2405464",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I.2405464",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oregon, OH

Sources for this page

Verify at the official NPI Registry.