Provider Demographics
NPI:1033553219
Name:SMITH, JENNIFER L (MS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1101
Mailing Address - Country:US
Mailing Address - Phone:339-223-1993
Mailing Address - Fax:
Practice Address - Street 1:35 JOHN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1101
Practice Address - Country:US
Practice Address - Phone:339-223-1993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health