Provider Demographics
NPI:1902943913
Name:SMITHWICK, BRETT M
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:M
Last Name:SMITHWICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HWY 69, MILE POST 29 ALAMO
Mailing Address - Street 2:
Mailing Address - City:MAGDALENA
Mailing Address - State:NM
Mailing Address - Zip Code:87825
Mailing Address - Country:US
Mailing Address - Phone:505-854-2626
Mailing Address - Fax:505-854-2616
Practice Address - Street 1:HWY 169 MILE POST 29
Practice Address - Street 2:
Practice Address - City:MAGDALENA
Practice Address - State:NM
Practice Address - Zip Code:87825
Practice Address - Country:US
Practice Address - Phone:505-854-2626
Practice Address - Fax:505-854-2616
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0080141101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)