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General NPI Number Information
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NPI Number | 1669569703
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Entity Type | Individual
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Provider Name | ALAN MARC SMITH SC.D.
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Gender | Male
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 09/02/2015
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Provider Practice Location Address
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Address Line | 101 CAMBRIDGE ST 300
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City | BURLINGTON
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State | MA
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Zip | 01803-3768
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Country | US
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Telephone | 781-273-3399
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Fax | 781-273-3399
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Provider Business Mailing Address
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Address Line | 41 OLD STAGECOACH RD
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City | BEDFORD
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State | MA
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Zip | 01730-1296
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Country | US
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Telephone | 781-275-1095
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Fax | 781-273-3399
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2081
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License Number State | MA
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