=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396876843
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA P SMITH PH.D., MPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 09/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 CAMBRIDGE ST 300
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-3768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-366-0339
-----------------------------------------------------
Fax | 781-273-3399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 160 CURVE ST
-----------------------------------------------------
City | DEDHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02026-2127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-780-9119
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 7149
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 9882
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------