MEDICARE: MARISA NICOLE 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	101Y00000X	Counselor		MA

General Provider Information

NPI Number	:	1891647582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA NICOLE SMITH

Provider Business Mailing Address
First Line	:	28 ANDERSON ST APT 1
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02114-3649
Country	:	US
Telephone Number	:	508-431-8203
Fax Number	:

Provider Business Practice Location Address
First Line	:	54 MILLER ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-4725
Country	:	US
Telephone Number	:	617-847-1914
Fax Number	:

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

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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Directions to “ MARISA NICOLE SMITH ” Practice Location

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