Healthcare Provider Details

I. General information

NPI: 1700991684
Provider Name (Legal Business Name): DORIS M SMITH LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 JAQUES AVE
WORCESTER MA
01610-2476
US

IV. Provider business mailing address

401 PEAKHAM RD
SUDBURY MA
01776-2761
US

V. Phone/Fax

Practice location:
  • Phone: 508-860-1033
  • Fax: 508-860-1068
Mailing address:
  • Phone: 978-443-5702
  • Fax: 508-860-1068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1404
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: