1568597466 NPI number — MR. STEPHEN WOODFORD SMITH MSW LICSW

Table of content: MR. STEPHEN WOODFORD SMITH MSW LICSW (NPI 1568597466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568597466 NPI number — MR. STEPHEN WOODFORD SMITH MSW LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
STEPHEN
Provider Middle Name:
WOODFORD
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568597466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5050 WASHINGTON ST
Provider Second Line Business Mailing Address:
111
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-323-6409
Provider Business Mailing Address Fax Number:
781-721-0421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
898 MAIN ST
Provider Second Line Business Practice Location Address:
MARCUS MENTAL HEALTH ASSOCIATES
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01890-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-721-2737
Provider Business Practice Location Address Fax Number:
781-721-0421
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  103311 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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