Provider Demographics
NPI:1396031431
Name:SMITH, LISA CARYN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CARYN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COMMONWEALTH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1200
Mailing Address - Country:US
Mailing Address - Phone:617-353-9610
Mailing Address - Fax:617-353-9609
Practice Address - Street 1:900 COMMONWEALTH AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1200
Practice Address - Country:US
Practice Address - Phone:617-353-9610
Practice Address - Fax:617-353-9609
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7881103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral