Individual
MR. MATTHEW JOHN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
610 WAMPANOAG TRL, RIVERSIDE, RI 02915-1504
(401) 431-9870
Mailing address
97 JONES RD, HOPEDALE, MA 01747-1143
(508) 473-6282
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW00312
RI
1041C0700X
Clinical Social Worker
SW110857
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3005223
BLUE CROSS
RI
01
—
407869
BLUE CHIP
RI
01
—
6236942
UNITED BEHAVIORAL HEALTH
RI
05
—
MS05223
—
RI
Enumeration date
08/29/2006
Last updated
07/08/2007
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