Individual
MR. WALTER JOHN SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC 1
Contact information
Practice address
435 WARREN ST, ROXBURY, MA 02119-1833
(617) 541-3670
Mailing address
435 WARREN ST, ROXBURY, MA 02119-1833
(617) 541-3670
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1930
MA
Other
Enumeration date
09/01/2009
Last updated
09/01/2009
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