Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | 11043 | MA |
NPI | 1144646993 |
---|---|
Provider Name | Kevin Smith |
First Address | Lynnfield, MA 01940-1345 |
Second Address | Lynnfield, MA 01940-1345 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2014 |
Last Update Date | 17/03/2014 |