Healthcare Provider Details

I. General information

NPI: 1447397146
Provider Name (Legal Business Name): CYNTHIA ANN SMITH RN,MS,CS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

992 GREAT PLAIN AVE SUITE 21
NEEDHAM MA
02492-2561
US

IV. Provider business mailing address

992 GREAT PLAIN AVE SUITE 21
NEEDHAM MA
02492-2561
US

V. Phone/Fax

Practice location:
  • Phone: 781-455-6223
  • Fax: 781-444-0905
Mailing address:
  • Phone: 781-455-6223
  • Fax: 781-444-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number149569
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: