MEDICARE: DEVON ELIZABETH SMITH LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	213664	MA

General Provider Information

NPI Number	:	1053458851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON ELIZABETH SMITH LICSW

Provider Business Mailing Address
First Line	:	709 E 6TH ST
Second Line	:	APT #1
City	:	SOUTH BOSTON
State	:	MA
Zip	:	02127-4305
Country	:	US
Telephone Number	:	978-979-7816
Fax Number	:

Provider Business Practice Location Address
First Line	:	255 HIGHLAND AVE
Second Line	:
City	:	NEEDHAM
State	:	MA
Zip	:	02494-3023
Country	:	US
Telephone Number	:	781-433-0672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	12/02/2008

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