Healthcare Provider Details

I. General information

NPI: 1972431112
Provider Name (Legal Business Name): JULIAN LEWIS SMITH
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 BLUE HILL AVE
DORCHESTER MA
02124-2902
US

IV. Provider business mailing address

1616 BEACON ST APT 2
BROOKLINE MA
02446-2272
US

V. Phone/Fax

Practice location:
  • Phone: 617-506-8188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: