Provider Demographics
NPI:1083748628
Name:SMITH, WILLIAM ROBERT SR (LPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ROBERT
Last Name:SMITH
Suffix:SR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CATASAUQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18032-1409
Mailing Address - Country:US
Mailing Address - Phone:610-264-5326
Mailing Address - Fax:610-865-1526
Practice Address - Street 1:35 E ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6505
Practice Address - Country:US
Practice Address - Phone:610-865-4228
Practice Address - Fax:610-865-1526
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002571101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral