MEDICARE: DR JESSE SMITH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1972374585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR JESSE SMITH THERAPY LLC

Provider Business Mailing Address
First Line	:	1807 WATERLOO ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 WATERLOO ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-2422
Country	:	US
Telephone Number	:	484-278-3319
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JESSE ALLEN SMITH
Credential	:	LMFT
Telephone Number	:	484-278-3319

Provider Enumeration Date	:	01/11/2024
Last Update Date	:	01/11/2024

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