Provider Demographics
NPI:1053719625
Name:SMITH, KARI LYNN (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3921 CENTER STREET RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-9445
Mailing Address - Country:US
Mailing Address - Phone:315-730-6558
Mailing Address - Fax:315-554-8118
Practice Address - Street 1:29 FENNELL ST
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-1117
Practice Address - Country:US
Practice Address - Phone:315-730-6558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0868051104100000X
NY084342-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker