Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 000226035 | MA |
NPI | 1003423815 |
---|---|
Provider Name | Abigail Smith |
First Address | Scituate, MA 02066-3455 |
Second Address | Jamaica Plain, MA 02130-1293 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2020 |
Last Update Date | 25/09/2020 |