Provider Demographics
NPI:1568597466
Name:SMITH, STEPHEN WOODFORD (MSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:WOODFORD
Last Name:SMITH
Suffix:
Gender:M
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 1:5050 WASHINGTON ST
Mailing Address - Street 2:111
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02132
Mailing Address - Country:US
Mailing Address - Phone:617-323-6409
Mailing Address - Fax:781-721-0421
Practice Address - Street 1:898 MAIN ST
Practice Address - Street 2:MARCUS MENTAL HEALTH ASSOCIATES
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1913
Practice Address - Country:US
Practice Address - Phone:781-721-2737
Practice Address - Fax:781-721-0421
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103311101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04511Medicare ID - Type Unspecified