Basic Information
| Provider Information | |||||||||
| NPI: | 1558520304 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | KATHRYN | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 294 WADLEIGH FALLS RD | ||||||||
| Address2: | |||||||||
| City: | NEWMARKET | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038572130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2075515344 | ||||||||
| FaxNumber: | 2074924889 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 MANOR PKWY | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030792841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074933361 | ||||||||
| FaxNumber: | 2074924889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2008 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | MC11634 | ME | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | EL05000 | NH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.