Healthcare Provider Details

I. General information

NPI: 1275333031
Provider Name (Legal Business Name): SUMMER RAE SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 MAIN ST
BLACKSTONE MA
01504-2215
US

IV. Provider business mailing address

425 BORDER ST APT 501
BOSTON MA
02128-5445
US

V. Phone/Fax

Practice location:
  • Phone: 574-948-1320
  • Fax: 774-220-5909
Mailing address:
  • Phone: 574-948-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: