Healthcare Provider Details

I. General information

NPI: 1548456221
Provider Name (Legal Business Name): ANTHONY DENNIS SMITH MS, LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MAIN ST
INDIAN ORCHARD MA
01151-1228
US

IV. Provider business mailing address

27 CHARLES ST
HAMPDEN MA
01036-9719
US

V. Phone/Fax

Practice location:
  • Phone: 413-543-5865
  • Fax: 413-543-2202
Mailing address:
  • Phone: 413-566-3501
  • Fax: 413-543-2202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6147
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: