Healthcare Provider Details

I. General information

NPI: 1295874683
Provider Name (Legal Business Name): JONATHAN JAMES SMITH M.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 HUNTINGTON AVE
BOSTON MA
02115-4506
US

IV. Provider business mailing address

55 BAYBERRY HILL RD
ATTLEBORO MA
02703-5801
US

V. Phone/Fax

Practice location:
  • Phone: 617-267-3700
  • Fax:
Mailing address:
  • Phone: 508-809-9473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1016656
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: