Provider Demographics
NPI:1629292891
Name:SMITH, WILLIAM CHARLES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:SMITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-2818
Mailing Address - Country:US
Mailing Address - Phone:724-532-1543
Mailing Address - Fax:
Practice Address - Street 1:121 W 2ND AVE
Practice Address - Street 2:BEHAVIORAL HEALTH
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1068
Practice Address - Country:US
Practice Address - Phone:724-537-1650
Practice Address - Fax:724-537-1918
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0128671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007610520006Medicaid