Provider Demographics
NPI:1962709774
Name:SMITH, CHARLES G (MSW, LSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:G
Last Name:SMITH
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOOD AVE S
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2749
Mailing Address - Country:US
Mailing Address - Phone:732-744-6355
Mailing Address - Fax:
Practice Address - Street 1:101 WOOD AVE S
Practice Address - Street 2:8TH FLOOR
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2749
Practice Address - Country:US
Practice Address - Phone:732-744-6355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05536000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker