Provider Information for 1316483316
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BENJAMIN W SMITH Jr. LCSW
Sex: Male
NPI: 1316483316
Last Updated: 2018-01-17
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1316483316 | ||||||||
| Enumeration Date | 2017-01-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 13059 BELFAST, ME 04915-4021 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 3900 WASHINGTON AVE STE 100 EVANSVILLE, IN 47714-0550 United States Phone: 812-485-6694 | Fax: | ||||||||
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