Provider Demographics
NPI:1447397146
Name:SMITH, CYNTHIA ANN (RN,MS,CS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN,MS,CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:992 GREAT PLAIN AVE
Mailing Address - Street 2:SUITE 21
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2561
Mailing Address - Country:US
Mailing Address - Phone:781-455-6223
Mailing Address - Fax:781-444-0905
Practice Address - Street 1:992 GREAT PLAIN AVE
Practice Address - Street 2:SUITE 21
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2561
Practice Address - Country:US
Practice Address - Phone:781-455-6223
Practice Address - Fax:781-444-0905
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149569163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPN0207OtherBCBS
MA401361OtherTUFTS
MAPN0207OtherBCBS