Provider Demographics
NPI:1598817884
Name:SMITH, CHRISTOPHER W
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:W
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MILLBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2552
Mailing Address - Country:US
Mailing Address - Phone:302-252-1023
Mailing Address - Fax:302-266-9977
Practice Address - Street 1:31 MILLBROOK RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2552
Practice Address - Country:US
Practice Address - Phone:302-252-1023
Practice Address - Fax:302-299-6677
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00013251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000040882Medicaid