Kelly R Smith, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW018796 Issued in PA

Practice address

21 Main St
Towanda, PA 18848-1803

Phone

(570) 265-2525

NPI assigned

Dec 4, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Mental Health Associates of North Central PA

  • Clinic/Center
  • Laporte, PA
  • NPI 1891093001
  NPD (past)

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

{
    "created_epoch": "1354579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1457696395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 FRANKLIN ST",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 MAIN ST",
            "city": "TOWANDA",
            "state": "PA",
            "postal_code": "188481803",
            "telephone_number": "570-265-2525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "512 Desmond St",
            "address_purpose": "LOCATION",
            "city": "Sayre",
            "state": "PA",
            "postal_code": "188402404",
            "country_code": "US",
            "telephone_number": "570-888-4005",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "R",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-04",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "PA",
            "license": "SW129114",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW018796",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David A Shaller, MD
• John Andrew Slater, DPT
• Brittany Michelle Smith, RPH
• Echo Ingham Smith, PT
• Kelli Lynn Smith, PT
• Amy Soper
• Sarah M Sorlien, MD
• Clark Joseph Sparrow, D.D.S.
• Spectrum Therapeutic Services Inc
• Tyler Lee Spencer, LPC

• Clinical Social Worker in Towanda, PA
• Providers in Towanda, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.