Provider Demographics
NPI:1932437381
Name:SMITH, LUKE DAVID HAWKEYE (LICSW)
Entity Type:Individual
Prefix:
First Name:LUKE DAVID
Middle Name:HAWKEYE
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 1:123 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3516
Mailing Address - Country:US
Mailing Address - Phone:413-658-8768
Mailing Address - Fax:
Practice Address - Street 1:20 FEDERAL ST STE 2
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3324
Practice Address - Country:US
Practice Address - Phone:413-658-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-23
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0300060OtherMBHP
MA1300881Medicaid