Provider Demographics
NPI:1073759817
Name:SMITH, SCOTT M (MA, LMHC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-2162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:152 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-2162
Practice Address - Country:US
Practice Address - Phone:508-885-5650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health