Individual
DR. JEAN L SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
11 HOMER ST, NEWTON CENTRE, MA 02459-1510
(617) 558-8880
Mailing address
398 LOWELL AVE, NEWTONVILLE, MA 02460-2152
(617) 558-8880
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
MA LIC # 2589
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0509175
—
MA
Enumeration date
01/26/2007
Last updated
07/08/2007
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