Sean Smith-Moore, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149019678 Issued in IL

Practice address

4309 N Kenmore Ave Unit 2
Chicago, IL 60613-7352

Phone

(301) 974-5985

NPI assigned

Nov 19, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other names 1

• Sean Smith 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": "1447891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1629442231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5068 N WINCHESTER AVE APT 3N",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606407896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 N KENMORE AVE UNIT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606137352",
            "telephone_number": "301-974-5985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH-MOORE",
        "first_name": "SEAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-11-19",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "34978",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "DC",
            "license": "LG50081367",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MD",
            "license": "20792",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149019678",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SEAN",
            "last_name": "SMITH",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Olivia Smith-Huang, LMSW, LCSW
• Courtney Classen Smith-Matthews
• Eryn Smith-Moeller, LCPC
• Diavione Smith-Moore
• John Patrick Smith-Moore, LCSW
• Janekqua Anae Smith-Nickson
• Terry Quinn Smith-Roberts, MD
• Vanessa Smith-Woods
• Aaron Smith, MD
• Abigail Linn Smith, M.D.

• Clinical Social Worker in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2021; 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.