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Individual
MR. MICHAEL SMITH
Active
Individual
MR. MICHAEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
117423
MA
1041C0700X
Clinical Social Worker
CSW00841
RI
1041C0700X
Clinical Social Worker
ISW01811
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1020890
BEACON/NHP
RI
05
—
MS59551
—
RI
Enumeration date
06/13/2006
Last updated
12/10/2015
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