Individual
MARK WILLIAM SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
5939 PORTLAND AVE, MINNEAPOLIS, MN 55417-3127
(612) 866-6100
(612) 866-9379
Mailing address
5939 PORTLAND AVE, MINNEAPOLIS, MN 55417-3127
(612) 866-6100
(612) 866-9379
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11372
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102R8SM
BLUE CROSS BLUE SHIELD
MN
Enumeration date
04/04/2007
Last updated
07/09/2007
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