Provider Demographics
NPI:1578525564
Name:SMITH, AMY L (LCSW)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 PALM DR
Mailing Address - Street 2:
Mailing Address - City:GREENLAND
Mailing Address - State:NH
Mailing Address - Zip Code:03840-2120
Mailing Address - Country:US
Mailing Address - Phone:603-436-2172
Mailing Address - Fax:
Practice Address - Street 1:50 MOODY ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1536
Practice Address - Country:US
Practice Address - Phone:207-294-4657
Practice Address - Fax:207-294-4649
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC59491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical