MEDICARE: SUMMER RAE SMITH

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1275333031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER RAE SMITH

Provider Business Mailing Address
First Line	:	425 BORDER ST APT 501
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02128-5445
Country	:	US
Telephone Number	:	574-948-1320
Fax Number	:

Provider Business Practice Location Address
First Line	:	61 MAIN ST
Second Line	:
City	:	BLACKSTONE
State	:	MA
Zip	:	01504-2215
Country	:	US
Telephone Number	:	574-948-1320
Fax Number	:	774-220-5909

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

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	06/01/2026

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Directions to “ SUMMER RAE SMITH ” Practice Location

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