Provider Demographics
NPI:1629340484
Name:SMART, SHAHI LAVAIL SR
Entity Type:Individual
Prefix:MR
First Name:SHAHI
Middle Name:LAVAIL
Last Name:SMART
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 BORDER ST
Mailing Address - Street 2:#D
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2408
Mailing Address - Country:US
Mailing Address - Phone:617-271-0592
Mailing Address - Fax:
Practice Address - Street 1:512 BORDER STREET
Practice Address - Street 2:#D
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128
Practice Address - Country:US
Practice Address - Phone:617-271-0592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health