Individual
KELLY SMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1526 S HICKS ST, PHILADELPHIA, PA 19146-4821
(267) 540-8675
Mailing address
1526 S HICKS ST, PHILADELPHIA, PA 19146-4821
(215) 275-7185
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
SW136943
PA
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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