Provider Demographics
NPI:1568515005
Name:SMITH, JEFFREY SARGENT (LMHC, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:SARGENT
Last Name:SMITH
Suffix:
Gender:M
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GRANITE STATE CT
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2127
Mailing Address - Country:US
Mailing Address - Phone:508-240-1471
Mailing Address - Fax:508-240-1471
Practice Address - Street 1:26 GRANITE STATE CT
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2127
Practice Address - Country:US
Practice Address - Phone:508-240-1471
Practice Address - Fax:508-240-1471
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3050101YM0800X
MA440106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS029341OtherCHAMPUS
MA9397166OtherPHCS
MA7199181OtherAETNA
MA790687OtherTUFTS HEALTH PLAN
MALM0369OtherBLUE CROSS BLUE SHIELD MA