Provider Demographics
NPI:1629839642
Name:CIPRIAN, SMILL
Entity Type:Individual
Prefix:
First Name:SMILL
Middle Name:
Last Name:CIPRIAN
Suffix:
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 1:480 WILLIAM F MCCLELLAN HWY STE 302
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1389
Mailing Address - Country:US
Mailing Address - Phone:857-366-7040
Mailing Address - Fax:
Practice Address - Street 1:480 WILLIAM F MCCLELLAN HWY STE 302
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1389
Practice Address - Country:US
Practice Address - Phone:857-366-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor