Provider Demographics
NPI:1447523105
Name:SMITHSON, ROBERT ANDREW (LMSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ANDREW
Last Name:SMITHSON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 S 125 LN W
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-9660
Mailing Address - Country:US
Mailing Address - Phone:208-312-3648
Mailing Address - Fax:
Practice Address - Street 1:1334 MILLER AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1729
Practice Address - Country:US
Practice Address - Phone:208-312-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-31488104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker