Healthcare Provider Details

I. General information

NPI: 1619873825
Provider Name (Legal Business Name): SYDNEY C SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2026
Last Update Date: 10/15/2026
Certification Date: 10/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DUNHAM RIDGE ROAD SUITES 3200-3350
BEVERLY MA
01915
US

IV. Provider business mailing address

241 MIDDLE ST APT 9
PORTSMOUTH NH
03801-5180
US

V. Phone/Fax

Practice location:
  • Phone: 978-600-0816
  • Fax:
Mailing address:
  • Phone: 603-205-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: