Provider Demographics
NPI:1417017286
Name:SMITH, WILLIAM G (MSW LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461258
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80046-1258
Mailing Address - Country:US
Mailing Address - Phone:303-741-4958
Mailing Address - Fax:303-690-4207
Practice Address - Street 1:15700 E MONMOUTH PL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1724
Practice Address - Country:US
Practice Address - Phone:303-741-4958
Practice Address - Fax:303-690-4207
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9892021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC87326Medicare ID - Type Unspecified
COR98132Medicare UPIN