Healthcare Provider Details

I. General information

NPI: 1972735348
Provider Name (Legal Business Name): MARCIA R. SMITH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 08/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 DERBY ST SUITE 13
HINGHAM MA
02043-3728
US

IV. Provider business mailing address

68 SAMOSET AVE
QUINCY MA
02169-2354
US

V. Phone/Fax

Practice location:
  • Phone: 781-749-4600
  • Fax: 781-741-8341
Mailing address:
  • Phone: 617-650-6328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111021
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: