Individual
MICHAEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
89 CEDAR AVE, LAKE VILLA, IL 60046-8411
(847) 265-7300
(847) 265-7301
Mailing address
PO BOX 764, LAKE VILLA, IL 60046-0764
(847) 265-7300
(847) 265-7301
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
11170
WI
Other
Enumeration date
10/17/2019
Last updated
02/24/2025
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