Provider Demographics
NPI:1174886345
Name:SMITH, NANCY
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:HYANNIS PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02647-0725
Mailing Address - Country:US
Mailing Address - Phone:508-280-8268
Mailing Address - Fax:
Practice Address - Street 1:832 MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-2048
Practice Address - Country:US
Practice Address - Phone:508-280-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2189791041C0700X
MA1211671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical