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General NPI Number Information
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NPI Number | 1952172116
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Entity Type | Individual
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Provider Name | JESSICA ANNE MARIE SMITH M. ED.
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Gender | Female
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 01/15/2024
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Provider Practice Location Address
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Address Line | 109 RHODE ISLAND RD
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City | LAKEVILLE
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State | MA
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Zip | 02347-1370
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Country | US
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Telephone | 781-878-8340
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Fax |
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Provider Business Mailing Address
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Address Line | 24 MARION RD
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City | MATTAPOISETT
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State | MA
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Zip | 02739-2073
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Country | US
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Telephone | 857-222-7750
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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