Provider Demographics
NPI:1437644366
Name:SMITH, JILL ALICIA I
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:ALICIA
Last Name:SMITH
Suffix:I
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 1:85 E NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2841
Mailing Address - Country:US
Mailing Address - Phone:617-626-8700
Mailing Address - Fax:617-626-9982
Practice Address - Street 1:85 E NEWTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2841
Practice Address - Country:US
Practice Address - Phone:617-626-8700
Practice Address - Fax:617-626-9982
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-23
Last Update Date:2018-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1070041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical