Provider Demographics
NPI:1356497796
Name:SMITH, VALERIE (LIC AC)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:12 ARROW ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-5105
Mailing Address - Country:US
Mailing Address - Phone:617-349-3600
Mailing Address - Fax:617-349-3601
Practice Address - Street 1:12 ARROW ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-5105
Practice Address - Country:US
Practice Address - Phone:617-349-3600
Practice Address - Fax:617-349-3601
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA629171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist