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General NPI Number Information
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NPI Number | 1891153060
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Entity Type | Individual
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Provider Name | J B. SMITH LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 02/03/2016
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Provider Practice Location Address
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Address Line | 18 KINGS HWY SUITE 202
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2509
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Country | US
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Telephone | 732-533-8433
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Fax |
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Provider Business Mailing Address
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Address Line | 32 SPRUCE DR
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-3429
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Country | US
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Telephone | 732-533-8433
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05619200
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License Number State | NJ
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