Provider Demographics
NPI:1699074286
Name:SMITH, SCOTT M (LSW)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:M
Last Name:SMITH
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18701-1112
Mailing Address - Country:US
Mailing Address - Phone:570-823-5137
Mailing Address - Fax:570-824-4210
Practice Address - Street 1:71 W NORTHAMPTON ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18701-1112
Practice Address - Country:US
Practice Address - Phone:570-823-5137
Practice Address - Fax:570-824-4210
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW001684E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW001684EOtherBCNEPA