Provider Demographics
NPI:1790820165
Name:SMITH, HOWARD EVAN (MSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:HOWARD
Middle Name:EVAN
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 1:35 WARWICK ROAD
Mailing Address - Street 2:
Mailing Address - City:W NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465
Mailing Address - Country:US
Mailing Address - Phone:617-965-4568
Mailing Address - Fax:781-721-0421
Practice Address - Street 1:MARCUS MENTAL HEALTH ASSOCIATES
Practice Address - Street 2:898 MAIN STREET
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890
Practice Address - Country:US
Practice Address - Phone:781-721-2737
Practice Address - Fax:781-721-0921
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103305101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO1355Medicare ID - Type Unspecified