Provider Demographics
NPI:1447562244
Name:SMITH, ANDREW (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
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 1:25 LEAF LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02333-1614
Mailing Address - Country:US
Mailing Address - Phone:508-378-4721
Mailing Address - Fax:508-378-4721
Practice Address - Street 1:25 LEAF LN
Practice Address - Street 2:
Practice Address - City:EAST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02333-1614
Practice Address - Country:US
Practice Address - Phone:508-378-4721
Practice Address - Fax:508-378-4721
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-08
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1227101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor