Provider Demographics
NPI:1629406236
Name:SMITH, COLBORN WILLIAM (PHD)
Entity Type:Individual
Prefix:
First Name:COLBORN
Middle Name:WILLIAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 MAIN ST
Mailing Address - Street 2:SUITE 60
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-2439
Mailing Address - Country:US
Mailing Address - Phone:413-253-7662
Mailing Address - Fax:
Practice Address - Street 1:664 MAIN ST
Practice Address - Street 2:SUITE 60
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-2439
Practice Address - Country:US
Practice Address - Phone:413-253-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2184103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist