Provider Demographics
NPI:1699232611
Name:SMITH, RICHARD DEAN II (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:DEAN
Last Name:SMITH
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 N 36TH TER
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-1415
Mailing Address - Country:US
Mailing Address - Phone:816-341-3269
Mailing Address - Fax:
Practice Address - Street 1:724 N 22ND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2604
Practice Address - Country:US
Practice Address - Phone:816-364-1501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180317691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical