Provider Demographics
NPI:1669892899
Name:SMITH, LEIGH (LICSW)
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1874
Mailing Address - Country:US
Mailing Address - Phone:802-595-9023
Mailing Address - Fax:802-442-2137
Practice Address - Street 1:186 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1874
Practice Address - Country:US
Practice Address - Phone:802-595-9023
Practice Address - Fax:802-442-2137
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089.00648931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1028OtherVETERAN'S HEALTH ADMIN