Individual
THOMAS MICHAEL SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
90 HOPE DR BLDG 1900, MOUNTAIN HOME AFB, ID 83648
(208) 828-7580
Mailing address
106 OFFUTT RD, HANSCOM AFB, MA 01731-2634
(570) 977-2067
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
SW125549
PA
1041C0700X
Clinical Social Worker
Primary
CW016654
PA
Other
Enumeration date
05/14/2007
Last updated
06/27/2018
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