Provider Demographics
NPI:1053803452
Name:MATHEWS-SMITH, CHANDRA KAY (LISW-S)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:KAY
Last Name:MATHEWS-SMITH
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 LITTLE DRY RUN RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45244-3247
Mailing Address - Country:US
Mailing Address - Phone:829-484-8296
Mailing Address - Fax:
Practice Address - Street 1:1165 EATON AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-1402
Practice Address - Country:US
Practice Address - Phone:513-868-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI0004850101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health