Provider Demographics
NPI:1548456221
Name:SMITH, ANTHONY DENNIS (MS, LMHC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:DENNIS
Last Name:SMITH
Suffix:
Gender:M
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:MA
Mailing Address - Zip Code:01036-9719
Mailing Address - Country:US
Mailing Address - Phone:413-566-3501
Mailing Address - Fax:413-543-2202
Practice Address - Street 1:529 MAIN ST
Practice Address - Street 2:
Practice Address - City:INDIAN ORCHARD
Practice Address - State:MA
Practice Address - Zip Code:01151-1228
Practice Address - Country:US
Practice Address - Phone:413-543-5865
Practice Address - Fax:413-543-2202
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-17
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6147101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional