Provider Demographics
NPI:1770613648
Name:SMITH, BRIAN EARL (LMHC)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:EARL
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 PINE ST
Mailing Address - Street 2:G B WELL HUMAN SERVICES CENTER
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-8002
Mailing Address - Country:US
Mailing Address - Phone:508-765-9167
Mailing Address - Fax:508-764-2462
Practice Address - Street 1:29 PINE ST
Practice Address - Street 2:G B WELL HUMAN SERVICES CENTER
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-8002
Practice Address - Country:US
Practice Address - Phone:508-765-9167
Practice Address - Fax:508-764-2462
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4844101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health