Healthcare Provider Details

I. General information

NPI: 1750702825
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL SMITH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 MILFORD ST
UPTON MA
01568-1309
US

IV. Provider business mailing address

206 MILFORD ST
UPTON MA
01568-1309
US

V. Phone/Fax

Practice location:
  • Phone: 508-529-7000
  • Fax:
Mailing address:
  • Phone: 508-529-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number088845
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: