Healthcare Provider Details

I. General information

NPI: 1528552619
Provider Name (Legal Business Name): HEATHER DUCKWORTH SMITH PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 SEAL COVE LN
HINGHAM MA
02043-1050
US

IV. Provider business mailing address

5 SEAL COVE LN
HINGHAM MA
02043-1050
US

V. Phone/Fax

Practice location:
  • Phone: 617-510-4203
  • Fax:
Mailing address:
  • Phone: 617-510-4203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number9004-PY-PR
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number9004-PY-PR
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: