Provider Demographics
NPI:1871655209
Name:SMITH, CRAIG (LADC, LICSW)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LADC, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05036-0487
Mailing Address - Country:US
Mailing Address - Phone:802-276-3726
Mailing Address - Fax:
Practice Address - Street 1:100 HOSPITALITY DRIVE
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05601-0560
Practice Address - Country:US
Practice Address - Phone:802-223-4156
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000331101YA0400X
VT089.00629861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT59045OtherBLUE CROSS
VT30Y001372VT01OtherANTHEM