Provider Demographics
NPI:1225312580
Name:SMITH, JEWELL C III
Entity Type:Individual
Prefix:MS
First Name:JEWELL
Middle Name:C
Last Name:SMITH
Suffix:III
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3313
Mailing Address - Country:US
Mailing Address - Phone:857-258-4521
Mailing Address - Fax:
Practice Address - Street 1:225 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3313
Practice Address - Country:US
Practice Address - Phone:857-258-4521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor