Provider Demographics
NPI:1043274764
Name:SMITH, WILLIAM H (MSW, ACSW, LISW, LCS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW, ACSW, LISW, LCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34900 CHARDON RD
Mailing Address - Street 2:STE 200
Mailing Address - City:WILLOUGHBY HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9161
Mailing Address - Country:US
Mailing Address - Phone:440-957-5600
Mailing Address - Fax:440-957-1293
Practice Address - Street 1:1210 W DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5224
Practice Address - Country:US
Practice Address - Phone:813-347-4462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3609104100000X
FLSW 90671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP52998Medicare UPIN
OHSMSW24654Medicare ID - Type Unspecified