Provider Demographics
NPI:1033437256
Name:SMITH, STEPHEN L
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:L
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LUPIN WAY
Mailing Address - Street 2:
Mailing Address - City:EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02642-2129
Mailing Address - Country:US
Mailing Address - Phone:508-246-6152
Mailing Address - Fax:
Practice Address - Street 1:500 LONG POND DRIVE
Practice Address - Street 2:
Practice Address - City:S. YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-2129
Practice Address - Country:US
Practice Address - Phone:508-760-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker