Provider Demographics
NPI:1912545799
Name:SMITH, AMASA (LICSW)
Entity Type:Individual
Prefix:MR
First Name:AMASA
Middle Name:
Last Name:SMITH
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 NORTH STREET
Mailing Address - Street 2:#405
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-9970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:121 NORTH STREET
Practice Address - Street 2:#405
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-9970
Practice Address - Country:US
Practice Address - Phone:617-807-0077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1225771041C0700X
1041C0700X
CO099251111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA122577OtherLICENSED CLINICAL SOCIAL WORKER
CO09925111OtherLICENSED CLINICAL SOCIAL WORKER
RIISW03251OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER