Healthcare Provider Details

I. General information

NPI: 1184685430
Provider Name (Legal Business Name): BARBARA SARAH SMITH MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 MAIN RD
WESTPORT MA
02790-4411
US

IV. Provider business mailing address

1664 MAIN RD
WESTPORT MA
02790-4411
US

V. Phone/Fax

Practice location:
  • Phone: 508-636-7569
  • Fax:
Mailing address:
  • Phone: 508-636-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104191
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07027
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: