Provider Demographics
NPI:1477038032
Name:RUSSELL-SMITH, BETH DORCAS (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:DORCAS
Last Name:RUSSELL-SMITH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01073-9358
Mailing Address - Country:US
Mailing Address - Phone:413-695-0662
Mailing Address - Fax:
Practice Address - Street 1:84 HIGH ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01073-9358
Practice Address - Country:US
Practice Address - Phone:413-695-0662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-30
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10156911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1015691OtherCOMMONWEALTH OF MA DIV OF PROFESSIONAL LICENSURE