Provider Demographics
NPI:1174399869
Name:SMITH PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:SMITH PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AMASA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-807-0077
Mailing Address - Street 1:121 NORTH STREET, #405
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-9970
Mailing Address - Country:US
Mailing Address - Phone:617-807-0077
Mailing Address - Fax:
Practice Address - Street 1:121 NORTH STREET, #405
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-9970
Practice Address - Country:US
Practice Address - Phone:617-807-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA122577OtherLICSW