Kenneth Gregory Smith, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C004052 Issued in NC

Practice address

3425 Melrose Rd
Fayetteville, NC 28304-1608

Phone

(910) 609-3700

Fax

(910) 609-3784

NPI assigned

May 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NC

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Cumberland County Communicare, Inc

  • Community/Behavioral Health Agency
  • Fayetteville, NC
  • NPI 1255539870
  Medicare reassignment
• Life and Health Psychology Associates Inc.

  • Counseling Psychologist
  • Seminole, FL
  • NPI 1376752246
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196640000000",
    "number": "1356397004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3425 MELROSE RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283041608",
            "telephone_number": "910-609-3700",
            "fax_number": "910-609-3784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3425 MELROSE RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283041608",
            "telephone_number": "910-609-3700",
            "fax_number": "910-609-3784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KENNETH",
        "middle_name": "GREGORY",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-25",
        "last_updated": "2007-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C004052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6002984",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSURE",
            "identifier": "C004052",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Kurtz Smith, MSN, CNM
• Kendall Smith
• Kendall Spencer Smith, FNP
• Kendrick Smith
• Kenesha N Smith
• Kim W Smith, NP C
• Lindsay Smith, AU.D.
• Madeline Smith, AUD
• Madilyn Smith, PTA
• Madison Smith

• Clinical Social Worker in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.