| Alfonzo Smith Llc | |
|
18641 Wyoming St Detroit MI 48221-2009 | |
| (313) 283-7527 | |
| Not Available |
| Full Name | Alfonzo Smith Llc |
|---|---|
| Speciality | Social Worker |
| Location | 18641 Wyoming St, Detroit, Michigan |
| Authorized Official Name and Position | Alfonzo Smith (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3132837527 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alfonzo Smith Llc 18641 Wyoming St Detroit MI 48221-2009 Ph: (313) 283-7527 | Alfonzo Smith Llc 18641 Wyoming St Detroit MI 48221-2009 Ph: (313) 283-7527 |
| NPI Number | 1730941188 |
|---|---|
| Provider Enumeration Date | 01/30/2024 |
| Last Update Date | 01/30/2024 |
| Certification Date | 01/30/2024 |
| Medicare PECOS PAC ID | 6800231416 |
|---|---|
| Medicare Enrollment ID | O20240305000873 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730941188 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Alfonzo Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1407274848 PECOS PAC ID: 8527403146 Enrollment ID: I20240305001534 |
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