Doctor Name: | DR. JEAN L SMITH |
NPI Number: | 1225184039 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PH.D. |
License Number: | MA LIC # 2589 |
Business Practice Address: | 11 Homer St Newton Centre, MA - 024591510 |
Business Phone Number: | 6175588880 |
Business Fax Number: | |
Mailing Address: | 398 Lowell Ave, NEWTONVILLE |
State: | MA |
Postal Code: | 024602152 |
Phone Number: | 6175588880 |
Fax Number: | |
NPI Enumeration Date: | 01/26/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | MA LIC # 2589 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |