Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 102L00000X | Psychologist | 9355 | MA |
Y | 103T00000X | Psychologist | 9355 | MA |
NPI | 1013238864 |
---|---|
Provider Name | Dr. Debborah E. Smyth |
First Address | Worcester, MA 01606-2714 |
Second Address | Auburn, MA 01501-2498 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2010 |
Last Update Date | 13/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042197449 | TRICARE (01) | MA |