Provider Demographics
NPI:1861777609
Name:SMITH, JENNIFER MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 WHITTIER PL STE 108
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-1408
Mailing Address - Country:US
Mailing Address - Phone:802-755-5441
Mailing Address - Fax:617-651-5815
Practice Address - Street 1:190 MAIN ST STE 306
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-2837
Practice Address - Country:US
Practice Address - Phone:802-755-5441
Practice Address - Fax:617-668-1401
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT048.0134932103TC1900X
MA9419103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling