Provider Demographics
NPI:1043030240
Name:SMOCK, MICHAEL JOSEPH (MSW, LSW, LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:SMOCK
Suffix:
Gender:M
Credentials:MSW, LSW, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8791 WOLFF CT STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-3693
Mailing Address - Country:US
Mailing Address - Phone:720-663-8084
Mailing Address - Fax:
Practice Address - Street 1:8791 WOLFF CT STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-3693
Practice Address - Country:US
Practice Address - Phone:720-583-5256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK21192104100000X
COLSW.0009925272104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker