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General NPI Number Information
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NPI Number | 1376335612
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Entity Type | Individual
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Provider Name | JACLYN NICOLE SMITH
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Gender | Female
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Dates
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Enumeration Date | 05/21/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 1 ASHBURTON PL FL 3
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City | BOSTON
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State | MA
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Zip | 02108-1518
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Country | US
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Telephone | 857-214-0518
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Fax |
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Provider Business Mailing Address
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Address Line | 214 E MOUNTAIN ST APT J152
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City | WORCESTER
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State | MA
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Zip | 01606-1216
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Country | US
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Telephone | 646-334-4505
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSWA416373
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License Number State | MA
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