Healthcare Provider Details

I. General information

NPI: 1053458851
Provider Name (Legal Business Name): DEVON ELIZABETH SMITH LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 HIGHLAND AVE
NEEDHAM MA
02494-3023
US

IV. Provider business mailing address

709 E 6TH ST APT #1
SOUTH BOSTON MA
02127-4305
US

V. Phone/Fax

Practice location:
  • Phone: 781-433-0672
  • Fax:
Mailing address:
  • Phone: 978-979-7816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number213664
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: